Tackling Health Inequalities in Surgical Care

Lewisham and Greenwich NHS Trust collaborated with Healthwatch Greenwich to co-design solutions aimed at helping patients optimise their health before undergoing surgery. A series of seven discussion sessions brought together patients on LGT’s waiting list for surgery and community members living within LGT’s catchment area. Participants included individuals from global majority backgrounds, those with mental health needs, people living with disabilities, and parents and carers of people with learning disabilities. These discussion sessions focused on sharing their lived experiences and perspectives to co-design the support needed to improve their health during the surgical care pathway.

 Many patients and community members described the waiting period for surgery as a time filled with anxiety, feelings of isolation and a sense of being forgotten. This time was often characterised as their lives “being on hold”, preventing them from fully participating in activities they once enjoyed or making plans due to uncertainty around the timings for their operation. The lack of regular communication from the Trust intensified these feelings, leading some to worry about whether they were still on the waiting list. The uncertainty was especially challenging for those trying to coordinate work commitments, caregiving responsibilities, or personal plans. 

Patients and community members expressed the need for personalised information, guidance, and support to help optimise their health. They preferred tailored approaches that considered their health conditions, circumstances, and cultural contexts. Generic leaflets and advice often failed to resonate, lacking relevance to their lives and not offering actionable steps to meet their specific needs. For instance, advice that did not align with cultural traditions or did not consider their daily living realities was unhelpful. Additionally, family members and carers reported feeling overlooked, with insufficient guidance on how to support their loved ones in improving their health while waiting for surgery. Those who were carers themselves and awaiting surgery also sought tailored support to help manage their health alongside their caregiving responsibilities. Emphasis was placed on the importance of including partners, families, and carers in support programmes.

Access to clear, understandable, and relevant information was identified as a critical need. Patients and community members noted that difficult jargon and complex health communication were significant barriers. Even individuals who were fluent in English reported challenges in understanding technical terms, while others with limited English often relied on younger family members for translation, which sometimes led to inaccuracies and miscommunication, especially when concepts lacked direct translations in their languages. People 6 living with disabilities, such as visual impairments, highlighted inconsistencies in applying the Accessible Information Standard2 , which left them unable to access crucial information. They described feeling excluded and disempowered due to the lack of accessible materials.

Accountability and community support were considered vital for helping patients and community members remain motivated to improve their preoperative health. Peer support and community networks were viewed as valuable resources. Patients and community members described how sharing experiences with others they identified with, or who faced similar challenges, provided encouragement and inspiration to take proactive steps toward health improvement. Family support was also crucial in helping individuals stay focused on their health goals.

 Three key moments in the patient pathway were identified as optimal for providing personalised and tailored information, guidance, and support to improve health while waiting for surgery: 

• Referral appointment
• Waiting for surgery
• Preoperative appointment 

The referral appointment often marks the first point of contact in the surgical pathway. Early communication can increase awareness of the importance of improving health before surgery. Clear and accessible communication, along with tailored support at this stage, sets expectations and introduces a sense of accountability. This appointment provides an opportunity to build trust by addressing individual circumstances, including cultural, linguistic, caregiving, or disability-related needs. By doing so, patients feel supported, and any barriers or equity issues can be identified and addressed early on.

The waiting period for surgery is often the longest and most emotionally challenging phase for patients, but it also offers a chance for health improvement. With personalised guidance and tailored support, patients can make meaningful changes to enhance their readiness for surgery. Regular updates every three months on their status on the waiting list, along with personalised reminders and information on how to access support, can help maintain engagement and promote health during this period. 

For patients who may have struggled to implement changes earlier in the surgical pathway, the preoperative appointment serves as a final opportunity to address concerns and provide reassurance. At this point, actionable guidance that can realistically be implemented in the short time available before surgery should be offered. For patients who have made efforts to improve their health while waiting, this appointment can be used to provide motivation. If surgery is postponed due to a patient's poor health—especially when improvements are possible—personalised advice and tailored support should be given. 

This report highlights the value of co-designing solutions with patients and community members. This participatory approach builds trust and strengthens relationships between the Trust and the communities it serves. Through codesign, the Trust can create more inclusive models of care that reflect the diverse social, cultural, and economic backgrounds of its patient population. Engaging patients as partners in service development ensures that solutions are grounded in the realities of those who use and depend on these services. Solutions designed in collaboration with patients and community members are not only more likely to return positive outcomes but can also address barriers that contribute to health inequalities