Strengthening partnerships to improve primary care in the Deep End

Posted by Dr Angela Wearn, Associate Member of Fuse and Advocacy and Engagement Lead for the Deep End Network North East and North Cumbria

In this blog, Angela reflects on what people living in some of the region’s most disadvantaged communities have told the Deep End Network about challenges they face when it comes to accessing primary care, including attending appointments, and what we can do to improve this.

The Deep End Network is a growing GP-led international movement that began in Glasgow in 2009 as a response to the ‘inverse care law’, which is that those who need care the most often struggle the most to access it.

The North East and North Cumbria Deep End Network was established in 2020, with support from Fuse, the Centre for Translational Research in Public Health, and the NIHR Applied Research Collaboration North East and North Cumbria, creating a space for practitioners working in areas of severe socioeconomic disadvantage to share experience, shape solutions, and influence how primary care can better meet the needs of the people it serves.

Funded by the North East and North Cumbria Integrated Care Board, the Deep End Network focuses on four core priorities:

• Workforce: Building and retaining a well‑supported workforce in high‑need communities.
• Education: Strengthening training at all levels so current and future health professionals understand health inequalities and access to opportunities
• Advocacy: Ensuring Deep End practices and communities shape local and regional decisions on funding, access and service design.
• Research: Evaluating Deep End initiatives to understand what works, why it works, and how effective approaches can be scaled to improve outcomes.

Since 2023, I’ve been working as Advocacy and Engagement Lead to build and strengthen partnerships between Deep End communities, practitioners and researchers, ensuring the experiences and perspectives of underserved patients and communities inform both our research portfolio and the wider support and initiatives we offer practices.

Over this time, additional funding and support from across NIHR infrastructure, including the NIHR Applied Research Collaboration North East and North Cumbria, NIHR Three Schools and NIHR Research Delivery Network, has further supported targeted involvement and engagement work with those living in Deep End neighbourhoods, the majority of whom have had no previous experience of involvement in research or service development.

Support through the NIHR Three Schools collaboration was made possible through membership of Fuse, which is part of the NIHR School for Public Health Research, one of the three NIHR schools within the collaboration.

What we’re hearing from Deep End communities

Many Deep End patients face multiple, overlapping challenges including low income, insecure housing, poor mental or physical health, caring responsibilities, trauma, or homelessness. These pressures make it harder to engage with primary care, even when people want to.

Through conversations, workshops, and community-led sessions, people have shared why engagement can feel difficult:

• Personal pressures: the emotional and practical effort of attending can feel overwhelming and ‘too much’ on the day of the appointment.
• Feeling unheard or stigmatised: which makes reaching out feel pointless.
• Time and capacity: life can be busy, chaotic, and demanding, with health often taking a backseat.
• Overwhelming contact routes: getting through to the practice or accessing a suitable appointment can feel impossible.
• Negative past experiences: GP practices don’t always feel welcoming or safe.

Overall, I regularly hear that disengagement is rarely about disinterest, it’s about the collective barriers that build up and make staying connected to care difficult.

What communities say needs to change

Improving patient engagement in Deep End areas is complex. There is no single fix, and practices are working under significant resource constraints. But through our involvement work, communities have highlighted three priorities for investment and change that they feel would make a meaningful difference:

• Improve connection and communication
• Strengthen co‑design approaches
• Build sustainable, community‑based partnerships

These priorities align strongly with national ambitions around personalised care, prevention, and reducing inequalities, and they reflect what people say would help them feel more able to engage with primary care as the wider system shifts towards more integrated neighbourhood-level working.

Moving forward together

The NHS encourages practices to work closely with Patient Participation Groups (PPGs), but Deep End practices face additional challenges: limited resources, diverse patient needs, and complex barriers to involvement. From the community perspective, awareness of PPGs is low, confidence is often limited, and many people are unsure whether their voice will genuinely matter. To support better partnership working, the Deep End Public Advisory Group identified three simple involvement principles that are easy to remember and act upon, and clear enough to come back to when things get busy or complex:

• Make it easy
• Make it worthwhile
• Value patient experience

These principles are practical, community-informed and can be applied across a range of contexts to guide diverse involvement.

New one‑page resources for practices

To help bring these messages to life, we’ve co‑developed two infographics with Deep End patients, communities, and Nifty Fox. They distil community insights into quick, usable one-page resources that GP practices and other decision-makers can draw on to strengthen engagement and build more inclusive partnerships.

Supporting Patient Engagement in the Deep End: insights from the community
Working Better Together in the Deep End: patients and GP practices as partners

These resources will sit alongside a wider collection of materials, including a public‑facing animation and an illustrated impact report, which will be shared over the coming months. A celebration event is planned for early next year.

Why this matters

The Deep End Network exists because tackling health inequalities requires more than goodwill, it requires meaningful partnerships and system‑level commitment. These new resources are an important step in supporting practices and others to work alongside communities in ways that feel respectful, realistic, and rooted in the experiences of people who face the greatest barriers to accessing and influencing the care they receive.

We hope they support teams across the North East and North Cumbria and beyond to strengthen relationships, reduce barriers, and create primary care environments that are more responsive to the needs of communities most affected by health inequalities.

If you would like to know more about partnership working, co-production or our involvement work in the Deep End please contact Dr Angela Wearn (angela.wearn@newcastle.ac.uk)

Find out more about the Deep End Network

About the author

Dr Angela Wearn is Advocacy and Engagement Lead for the Deep End Network North East and North Cumbria and a Research Fellow with the NIHR Applied Research Collaboration North East and North Cumbria. She is also an Associate Member of Fuse, the Centre for Translational Research in Public Health.

Sparking curiosity with Twinkle, Twinkle Arti

Posted by Nicola Aldridge, Research Associate, and Cassey Muir, Research Associate / Co-lead of the Fuse Early Life and Adolescence Research Cluster, both from Newcastle University

We were recently given the exciting opportunity to showcase the Twinkle, Twinkle Arti project at Discover Festival, a free, one-day festival organised by Newcastle University that brings together families, communities, and researchers through interactive activities and inspiring ideas.

Nicola and Cassey

Discover Festival is designed to spark curiosity, build connections, and encourage people of all ages to explore new ideas. Each year, the university creates a packed programme of family-friendly events, and this year, we were delighted to be part of it as members of the Twinkle, Twinkle Arti research team.

Bringing Arti's story to life

Throughout the day, we invited families to step into Arti’s world through the Twinkle, Twinkle Arti storybook. Developed by Fuse researchers at Newcastle University, with funding from the NIHR School for Public Health Research, the book was created and co-produced with families to support the wellbeing of children experiencing challenging family circumstances, such as drug and alcohol use. While these experiences inspired the story, its themes of feelings, belonging, resilience, and hope resonate with all children.

Visitors to our stall in the Great North Museum had the chance to watch a CBeebies Bedtime Stories style video of it being read aloud by the author. They could also explore puppets and original illustrations from the book, and view artwork created by primary school-aged children who had participated in a pilot study of classroom lessons based on the story.

Families were also able to take home a free copy of the storybook, along with a link to the online read-aloud video and a set of simple conversation prompts designed to encourage creativity, emotional expression, and meaningful family time at home. We handed out nearly 80 copies on the day!

Conversations that matter

Beyond engaging with families, it was equally exciting to see the conversations that the project sparked among professionals attending the festival. We spoke with people from a range of sectors, including teaching, school governance, clinical psychology, and general practice with social prescribing links. Their curiosity about the project and enthusiasm for its potential applications highlighted the broad relevance of Twinkle, Twinkle Arti and the importance of creating accessible resources that support children's emotional and social wellbeing.

One particularly rewarding conversation was with a family who shared their personal experience of the impact of alcohol on family life and how they might be able to use the book. Hearing their reflections was both moving and affirming. It served as a powerful reminder of why the project began in the first place and reinforced the continued need for resources that help children navigate difficult experiences. Moments like these bring the research to life, reminding us that behind every study, storybook, and activity are real families whose experiences matter and whose voices continue to shape our work.

Creating a community star mural

Another highlight of the day was our evolving community star mural. We invited children to create their own star by drawing, colouring, or writing ideas about what they or Arti could do when they felt sad or worried, with 114 stars being created on the day. It was wonderful to see children enthusiastically embracing the activity, and even more special to watch parents, carers and grandparents join in too, talking to their children about the messages in the book. The excitement on their faces as they added their stars to the mural was a lovely reminder of the power of creativity to bring people together.

A colourful celebration of hope and resilience

By the end of the day, the mural had grown into a colourful display of hope, kindness, and imagination. It was a privilege to share the Twinkle, Twinkle Arti project with so many families and to see first-hand how children connected with Arti’s story and messages of hope, resilience and belonging. Events like Discover Festival provide a fantastic opportunity to bring research into the community, and we were grateful to be part of such an inspiring day.

Find out more about Twinkle, Twinkle Arti

• Read this Fuse blog about the development of Twinkle, Twinkle Arti
• Read about Twinkle, Twinkle Arti as a NIHR School for Public Health Research (SPHR) case study
• Read about piloting Twinkle, Twinkle Arti in primary schools
• Listen to this Fuse podcast to hear Cassey discussing her research on social and emotional resilience in children and young people affected by parental substance use.
• Download the book for free.
• Watch a video of the book being read aloud.

Moving from blame to support: rethinking food insecurity in diabetes

Posted by Ruth Boocock, Associate Professor and Dietitian, Teesside University, in Nutrition and Hydration Week.

This work started with a deceptively simple question: ‘How do clinicians identify food insecurity in people living with type 2 diabetes, and what actually helps once they do?’

By clinicians, I mean the people working directly with patients, for example GPs, nurses, dietitians, and others working in busy, often stretched diabetes services.

To explore this, I reviewed published research from across the world. Over many coffees, I read and debated papers, regularly asking other colleagues: ‘Is this really a pattern, or am I reading too much into it?’

What came through very clearly were the human stories beneath the data. Clinicians wanting to help, but constrained by time and systems. People with diabetes trying to manage blood glucose, while also worrying about whether there is enough food at home.

Asking about food only works if there’s something to offer next

Many clinicians want to ask patients about access to food and some already do, but the evidence shows that screening alone is not enough.

Without time, clear processes, or obvious referral routes, screening often stalls. I repeatedly came across similar experiences: ‘I asked the question. They said yes. And then I didn’t know what to do’. That moment matters. It can leave clinicians feeling stuck and distressed, and patients feeling exposed and unsupported.

One of the key messages from the evidence is that this isn’t about individual clinicians doing more. Food insecurity needs to be part of everyday systems, with prompts, shared responsibility across teams, and links to support that actually exists. Without that organisational backing, raising the issue of food tends to fall down the priority list, especially on busy clinic days.

Trust makes disclosure possible

You can’t script disclosure about food insecurity. People tend to talk when they feel listened to and not judged.

Shifts in practice, even just small changes in language came up repeatedly. A nurse replacing ‘Why aren’t you following the diet?’ with ‘What gets in the way?’ or a GP explaining ‘We ask everyone about access to food, because it can affect diabetes management.’

These shifts matter, they help move conversations away from blame and towards problem‑solving.

There was also a consistent tension between dietary advice and financial reality. Guidance may be clinically sound but still impossible to follow when money is tight. Recommended foods and ideal meal plans don’t always match what someone can afford or access.

Across the evidence, one message stood out, ‘Starting where people are really matters’. Advice framed around better, not perfect is far more likely to support engagement than aiming for an ideal that feels unreachable.

This isn’t something clinicians can fix alone

Many clinicians described feeling unsure where to send people for help. Knowledge of local food support was often limited or quickly out of date. Some avoided the conversation altogether, worried about raising an issue they couldn’t help with.

Where things seemed to work better was in areas with strong links between health services and community organisations such as food banks, pantries, community kitchens, and social prescribers. Not just signposting, but relationships and connection.

Another common theme was confidence and skills. Here, even when people accessed food support, they didn’t always feel able to turn unfamiliar ingredients into meals that worked for diabetes. Practical, community‑based support, including cooking sessions or simple recipe swaps helped bridge that gap.

What did I learn?

One of the biggest surprises was how rarely food insecurity appeared on its own. Transport costs, prepayment meters, missed appointments, and medication routines were often part of the same picture.

Stigma also ran throughout the existing research. Many people felt blamed for their diabetes and ashamed of needing help with food. Seen in that light, it becomes easier to understand why disclosure feels risky.

Perhaps most surprising was the impact of small system changes. Adding two evidence-based questions to patient records and a clear referral route doesn’t sound transformative. In practice, it can change conversations and access to support in very real ways.

Where I’ve landed

I started with the academic literature. I ended with a clearer sense that while food insecurity shows up in clinical settings, it isn’t something clinicians can or should be expected to solve alone.

If we want better diabetes outcomes, we need systems that make it:

• easier to ask about food
• realistic to respond to what we hear, and
• normal to work alongside community organisations beyond clinic walls.

My review is now published and available here.

If you’ve tried something that worked, or something that didn’t, I’d really like to hear about it. Being open about the messy space between screening and support feels like a good place to start.

Spark ideas, inspire change and fuel innovation - sharing research creatively

Posted by Ella Anderson, Fuse Public Involvement and Engagement Manager, Newcastle University

Have you ever wondered how to share your research in a way that engages with new and diverse audiences? Are there ways to share your work in a way that reaches the people it was designed to serve? If the answer is yes, then read on!

Research can spark ideas, inspire change and fuel innovation but all too often it gets buried in academic journals and dense reports that few people read, particularly the communities the research intends to serve. So what if there were more engaging, creative and accessible ways to share your findings? From interactive infographics and animations, to events, theatre and podcasts, Fuse researchers are re-imagining how to communicate their work with wider audiences.

Whether you are looking to captivate the public, influence policy makers or engage fellow experts, this post explores some creative ideas to make your research truly resonate.

• In the first instance, reach out to any people who you have worked with as part of your research including public partners, young people, charities and voluntary organisations. What would they like to see? Actively liaise with and listen to the communities your research is intending to serve - how do they want findings presented?

• Infographics and visual summaries can be a useful way to transform your findings into a simplified visual. Infographics are a graphic representation of information, data or knowledge to present complex content quickly and clearly. Emma Adams has worked with More than Minutes to summarise research about co-located services in a visual and accessible way. Steph Scott worked with Nifty Fox - specialists in visual storytelling - to produce a flipbook drawing on content from the ‘Divided Households’ report relating to children and parental imprisonment. Fuse Deputy Director Amelia Lake, Shelia Visram and team co-produced the Hyper Energy drink leaflet with young people to communicate key findings. Or what about a zine (DIY-style booklet or magazine) like this, ‘Moving Spaces’, co-produced by Caroline Dodd-Reynolds with LGBTQIA+ young people, exploring how physical activity spaces could be more joyful and safe.

• Short engaging videos, animations or explainers can be a great way to summarise research and impact. Using personal case studies or testimonials can make content more relatable to different audiences. For example, AskFuse (our research & evaluation service) collaborated with Newcastle Gateshead Clinical Commissioning Group to produce this video: How a 'Little Orange Book' is giving expert advice to help poorly kids.

• Theatre and performance is an exciting way of communicating research. For example, Cap-A-Pie and researchers including Mandy Cheetham were involved in developing an emotive theatre production called Credit, based on stories and experiences of people living on Universal Credit.

 

• Creative and engaging community events and workshops (with catering if you have budget!) are always a popular option. The more interactive, accessible and collaborative the better. Use the opportunity to close any feedback loops with people, charities, organisations who you have engaged with throughout the research. Show how you listened, what you found out, how findings are applicable to people's lives and work, and what happens next... keeping people in the loop is so important. Be sure to include opportunities for plain language Q&As and conversations, both informal (through breaks) and formal (via panel discussions). At one of Fuse’s International Women’s Day events, there was an optional gong bath for people attending the event. Although a sound bath may not have been directly linked to the research, the event was about creating a welcoming, inclusive and ‘safe space’ for people to come together.

• If you have the budget, consider having an event doodled in real-time. We have had colleagues who have worked with Camille Aubry, Josie Brookes and Nifty Fox who offer this skill. Get in touch with us if you would like any other recommendations when sourcing quotes.

• 
  Have you thought about gamification of research findings or using interactive digital tools? You can create interactive quizzes or clickable maps to allow people to explore findings in an engaging way, applying insights to local contexts. Simulation tools allow public partners and individuals to visualise the impact of different public health interventions based on research findings. Take a look at Joanne McGrath's online Maze, which provided an interactive resource portraying women’s narratives of multiple exclusion, homelessness and accessing support.

• Storytelling has long been a way to share information. Case studies lend themselves well to this, as human-centric narratives show the research in action. It can demonstrate how a specific person or community has benefitted or will benefit from the findings. Stories are a different way to 'humanise' data or translate findings in a way that is appropriate for the intended audience. For example, Cassey Muir and Ruth McGovern’s co-produced Twinkle Twinkle Arti children’s story book communicated messages about parental substance use in a gentle, age-appropriate manner. The book is available as a physical copy, an electronic copy and also has been made into a CBeebies style story time video.

• 
  Are there any opportunities for the use of creative methods throughout the project that you could bring together as part of an exhibition in a public space e.g. library, community centre, schools? Documenting the research and experience through photography, crafts or art can be a creative way of capturing interest and making research more understandable. Sarah Martin-Denham’s crochet blanket made up of 2,999 squares representing the number of children excluded every day from schools in England (2021/22 academic year) is a great example of this, and has been on a national tour engaging with 24 organisations - including the Children’s Commissioner Office and multiple councils.
  

• You can share bite-sized research or findings through social media channels using visuals, animations, short videos - or even livestreaming to provide information and engage with people in real-time. Have a hashtag at the ready to encourage people to join the conversation and share perspectives. In a similar vein, there are opportunities to share research and knowledge via 'Ask Me Anything' style forums, for example as seen on Reddit. Yes, this is low cost but it comes with risks as questions are unpredictable! However, it is worth flagging as an option and is a creative, ‘non-traditional’ way to share research and answer questions.

• Blogs, like the award-winning one you are reading right now, are a great way to share your research. Posts can make complex information more accessible to a wider audience. It allows you to present findings in a clear, engaging and informal style, reaching readers outside of academic circles, including policy makers, practitioners and the wider public. For guidance and support in writing your own blog post, contact Fuse Communications Manager, Mark Welford: m.welford@tees.ac.uk.

• Could you take your research findings to places in the local community? Fuse colleagues Balbir Singh (Artistic Director of the Balbir Singh Dance Company) and Paul Chazot displayed art works from their Unmasking Pain project in pop-up displays in GP surgeries and a repurposed shop in a shopping centre. There is now a dedicated space at the Grainger Market, Newcastle-upon-Tyne called the Being Well Place, which is a place to connect and engage with the local community.

• Do you have the option of translating materials/outputs for different audiences, and communities with diverse language needs? Translated summaries and visuals e.g. in multiple languages, work well and ensure inclusivity in dissemination. For example, Nicola Heslehurst worked with local designer, Twentyseven Design to develop English and Welsh infographics relating to pregnancy outcomes.

• And finally what kind of Fuse Public Involvement and Engagement Manager would I be if I wasn’t promoting the wonderful and award-winning public partner-led podcast Public Health Research and Me?! Accessible, informative, flexible and friendly - this is a great way to share quality research with a diverse and international audience. 

There are many more creative ways to share research and remember - there is a no ‘one-size-fits-all’ approach to sharing your findings. Always take into account your research topic, your findings and above all your target audience.

Why not send us a message today if you have used a creative or innovative way to share your research or findings? We would love to hear from you and find out more ways to promote and share high quality research.

---

Following strong interest from Fuse members, we have launched a Community of Practice (CoP) focused on creative research, involvement and dissemination.

The first meeting will take place in the New Year. Places are limited for the first event but please register or get in touch (info@fuse.ac.uk), as there will be plenty more opportunities in future!

A CoP is a network of people who share common interests and goals, creating a space for knowledge exchange, learning, and mutual support.

Nourishing our tomorrow needs to start today

Posted by Professor Amelia Lake, Fuse Deputy Director, and Professor of Public Health Nutrition at Teesside University

How do we create a future where every child has access to healthy, affordable food?

That question took centre stage at the British Nutrition Foundation annual conference, which brought together academics, policymakers, and practitioners to tackle one of the most pressing public health challenges of our time: improving the diets of children and young people.

The event was given a special highlight with the attendance of Her Royal Highness The Princess Royal, Patron of the British Nutrition Foundation, who delivered a powerful address on the importance of food in society and education.

Professor Amelia Lake and collegues meeting Her Royal Highness The Princess Royal

Children’s health and children’s diets are hugely important. Yet, rising rates of obesity, food insecurity, and exposure to unhealthy food environments challenge the ability to have affordable and healthy food.

This conference explored both the challenges and solutions, offering evidence-based insights and practical strategies.

I spoke in the morning session alongside my Fuse colleague Professor Greta Defeyter (Northumbria University) and Professor Maria Bryant (University of York). A great representation of Northern University academics!

Profs Maria Bryant, Greta Defeyter, Amelia Lake (L-R) 

Our morning session had a very special guest in the audience, Patron of the British Nutrition Foundation, Her Royal Highness The Princess Royal. Earlier the speakers were invited to meet The Princess Royal and individually talk to her about our work. A good ear for accents, Her Royal Highness. quickly recognised I wasn’t a Teesside native. Those who know me will be aware that I am from Northern Ireland, and I very much sound like I am.

My talk was titled: “Unpacking the Food Environment: Implications for Children and Families” and I discussed Healthy Planning and was able to introduce the audience not just to our academic evidence but also our evidence informed free online training on the topic aimed both at public health and planning teams in local authorities.

I presented our recent ‘Dark Kitchens’ research. The rise of online meal delivery and “dark kitchens” is reshaping how families access food, increasing exposure to calorie-dense options at the click of a button and increasing the availability of accessibility of less-healthy food choices.

While planning allows us to shape our food environment there is much we can do around food retail to create healthier food environments. I discussed some findings from our Fuse Foodscape study funded by the NIHR School for Public Health Research.

We cannot describe the food environment without acknowledging that many households face significant barriers to accessing affordable, healthy food, with direct consequences for children’s health and wellbeing. Food insecurity is real and affects families across the UK. At Teesside, we have worked with communities and organisations using innovative methods to produce healthy food within local social supermarkets such as our healthy ready meal.

Amelia speaking at the event

I called for stronger planning policies and interventions to create healthier food environments, emphasising the importance of collaboration between communities, professionals within local authorities, government and industry.

Improving dietary health isn’t simply about individual choice - it’s about transforming the food environments in which those choices are made.

Her Royal Highness The Princess Royal has been patron of the British Nutrition Foundation since 1988 and delivered a powerful speech at the conference, emphasising the importance of food in society and within education. Her remarks reinforced the British Nutrition Foundation’s mission to ensure every family can access a healthy, sustainable diets.

The conference showcased many impactful speakers and left us with the key message that Nourishing our tomorrow, needs to start today.

The British Nutrition Foundation hosted its annual conference, Nourishing Tomorrow: Equipping Children and Young People for Better Dietary Health in the Future took place on Tuesday 25 November 2025.

“It’s not something that you just openly discuss” - Supporting British South Asian carers affected by drug and alcohol use

Posted by Jayne Black, Public Health Officer, Harm Reduction and Social Inclusion, Public Health Directorate, Newcastle City Council

Access to services, such as those related to drugs and alcohol and other health services, can be challenging. This challenge may be harder for some minority communities due to a variety of additional factors which impact people from accessing support when required. It is important that we identify these issues and barriers that prevent people in need from accessing help.

PROPS Community Connector, Fatema Rahman (C) with colleagues Annette
  Walby (L) and Helen Thompson (R), celebrating Eid at Fenham Library

In Newcastle, an ethnic minority needs assessment has been carried out and is available on our Joint Strategic Needs Assessment webpage.

We have also partnered with Northumbria University to explore barriers and perceptions to accessing drug and alcohol support.

An important area of focus is how family members are affected by a loved one’s substance use. In Newcastle, a recent research project backed by Fuse seedcorn funding investigated the perspective of British South Asian carers, who care for people who use drugs and/or alcohol, regarding their experiences and access to specialist drug and alcohol carer services in Newcastle.

The collaboration which included, co-production with people with lived experience, was between Newcastle City Council, PROPS (Specialist Family Drugs and Alcohol Service), Northumbria and Newcastle Universities.

What do we know are some of the barriers?

Attitudinal (personal)

The limited research suggests that attitudinal barriers within minority groups exist in relation to accessing care services. These are suggested to be in relation to not wanting to involve services. This is due to low awareness of services and availability, and concerns around cultural or religious appropriateness.

Stigma

Stigma is harmful and has been defined as the devaluing of an individual based on their characteristics or behaviour.

We know that stigma in general can have an impact on whether an individual seeks support for alcohol or drug issues, or other health issues.

Within the British South Asian and Muslim community, it has been identified that societal stigma, within the community, can impact upon people’s willingness to access help. This stigma may be centred around concerns of what other members of the community perceive about a particular individual or family and their use of alcohol or drugs.

Carers

The research evidence within this area rarely extends to those who are in a caring role for family or friends who are struggling with issues around alcohol or drugs. This could be an important area of focus, as support from a family member or friend is incredibly important. Whether day-to-day or during recovery, supporting carers is vital. However, it is worth noting that some people may not identify or recognise themselves as a carer and therefore, are unaware of support.

The Census of England and Wales in 2021 identified that North East England has the highest number of people providing unpaid care. It also suggests that unpaid carers in the North East provide the most hours of care.

Providing care may impact the health and wellbeing of a carer, this could include financial as well as if someone is a kinship carer. Therefore, it is important to identify if there are barriers to accessing carer support services for people who care for family members or friends using drugs and or alcohol.

What did we discover?

Our research results identified a variety of key areas. These areas related to the topic of drugs and alcohol in terms of it being ‘taboo’, with associated stigma, the barriers that are experienced for accessing family support, along with the general awareness of family support services.

Drug and alcohol use as a taboo topic

Carers highlighted the difficulty of discussing their loved one’s use of drugs and alcohol with other people who are close to them. The topic itself can be seen as something which creates unease. This creates a possible negative effect as talking with others may help create a supportive network and help carers feel supported and provided with guidance.

“the drug use; it’s not something that you just openly discuss. It’s like [frowned] upon. You know, people, I think, blame the parents, “well why aren’t you doing something?” […] Unless somebody can help you, you know, guide you, there’s no point having these discussions with people […] I mean, I’ve spoke to their grandma about it and stuff. Like, people who genuinely care.” 

                                                                             Participant

In contrast, others mentioned conversations about drugs and alcohol being more prevalent in the community, requiring more awareness for community members.

Barriers to accessing family support

The issue of stigma is evident from the discussion, with drug and or alcohol use being seen as an individual issue of choice, which not only impacts the individual, but affects the reputation of the family. It is seen as different to mental health issues, as something that people are unable to physically observe or have an understanding of.

“I don’t even talk about his mental health condition, ‘cos it’s a stigma. People like, laugh at it and things and say, ‘look, he’s barking; he’s crazy’. It’s this whole attitude that he’s crazy. You know, there’s no sympathy. […] it’s better and easier to get cancer than it is to [have anything] like that, because no one’s going to be understanding. […] People don’t understand, they think they’re putting it on half the time. They’re not understanding the side effects that it has.” 

                                                                            Participant 

There is recognition that seeing or being aware of someone in a community accessing help for drugs and alcohol, or in recovery, can help shift perceptions and show that support is accessible to other members of the community.

Misconceptions around confidentiality and issues of trust can be seen within those working with services or accessing a service. Carers need to be reassured that services are bound by confidentiality. In terms of confidentiality within the community, raising awareness about available support can play a major role in reducing stigma associated with engagement and seeking support.

There is hope in the organisations that provide family support services, and allowing a carer to progress on their support journey at their own pace is important.

“I got involved with them and *the family support service* were really good, because at that time, I didn’t want anyone to know, ‘cos I didn’t know what was happening and they offered me so many different solutions and like, I don’t have to see them straight away […] Cos some people don’t want to talk about… You know what I mean? So at that time, I didn’t want to see who I am in this. I just wanted to understand what’s happening.” 

                                                                             Participant

Awareness of family support services

It was identified that there is limited knowledge of services that provide support for drug and alcohol recovery. This may create difficulty, as the role of the carer can be a ‘navigator’. Therefore, limited knowledge may add an additional pressure to the carer, which was an issue raised during the interviews.

Services reaching into communities, rather than people who require support finding their own their way, is highlighted as being a positive - which can be used to make recommendations for a future response.

Using an approach which makes the most of existing support already within communities and working at a pace that suits the carer. Also, harnessing the power and visible importance of communities can create a support network, ensuring assistance is sustainable and effective.

“Over the phone, it was fine. Then eventually, they came to my house. Eventually met in cafes, then started a course with them.”

“[They] are very good with giving me a variety of choices that suited me when I needed, so whatever suits you, with patients and carers, however it suits them. However it suits every individual is different, so they met my needs.”     

                                                                             Participant

Recommendations

We must connect with those who have relationships with members of a community to enhance trust and help support people who need it. Recommendations from the research included outreach into the community for connections with leaders. This must include vital considerations around caring and family support.

Encouraging visibility of services and people in recovery or who have lived experience within the community is also important to help not only the carers, but those who are struggling with the use of alcohol and drugs.

Developing work in Newcastle

Work in Newcastle is being developed within this area. Public Health have been engaging with British South Asian community leaders to enhance treatment and recovery efforts including carers. Two key meetings were held with stakeholders such as the Bangladeshi Association, local Imams, and university researchers. These meetings facilitated open dialogue on barriers to treatment, cultural sensitivities, and support systems, building trust and shared goals.

Engagement with the Health and Race Equality Forum (HAREF) emphasised the initiative's importance, with leaders showing enthusiasm for ongoing collaboration. A rough plan is being developed from these discussions, with next steps involving continued dialogue and refining the action plan to meet community needs. This approach highlights the value of community-led, culturally informed initiatives in promoting health equity.

Newcastle is also working with PROPS to fund a part time South Asian Muslim worker who will serve as a community connector to bridge the gap between community and support services. This is building on their existing effective practice in this space. The community connector worker will provide tailored support to facilitate access to support, ensuring carers, and families get the help they need in a culturally sensitive manner.

Personal reflection

The research highlights the importance of the voice from carers and communities, and those with lived experience. The importance of understanding the issues from those with lived experience who are supporting someone and working through any daily challenges. We must ensure that valuable information that we discover from research, such as this, is used to act and ensure that everyone has an opportunity to be supported and live well.

This isn’t just about food. It’s about fairness, dignity, and giving communities the tools they need to support themselves

Why Community Food Organisations deserve a place in the Child of the North APPG report

Posted by Andrea Burrows, Dr Claire O’Malley, Dr Helen Moore and Professor Amelia Lake, Fuse researchers from Teesside University

Andrea Burrows, Helen Moore with other contributors at the launch of the report in parliament

Across the North of England, families are facing a dual crisis: rising food insecurity and growing food waste. In response, Community Food Organisations (CFOs) - like social supermarkets and pantries - are stepping up in powerful, community led ways. These aren’t just places to get food. They’re places of dignity, connection, and hope.

But despite their growing role, CFOs are still flying under the radar. They’re under-researched, inconsistently defined, and often left out of the bigger policy picture. That’s why they were included in the Child of the North APPG report.

What is the Child of the North APPG?

The Child of the North All-Party Parliamentary Group (APPG) is a cross-party group of MPs, peers, researchers, and practitioners working together to tackle the deep-rooted inequalities affecting children in the North of England. From poverty and poor health to educational disadvantage, the APPG is committed to finding evidence-based solutions that give every child a fair start in life.

Backed by research from the Northern Health Science Alliance (NHSA), Health Equity North and the N8 Research Partnership, the APPG has already produced influential reports on the cost of living, education, and health. Now, it’s time to shine a light on food, and the role CFOs can play in transforming communities and the lives of children.

A different kind of food support

Unlike traditional food banks, CFOs operate more like supermarkets, offering surplus food at low prices. Often delivered in a familiar, retail-style setting, this model not only reduces food waste but also gives people choice and dignity in how they access food. It’s a far cry from the stigma that can come with emergency food aid.

Research shows that this approach better meets the needs of people experiencing food insecurity. It empowers them, rather than making them feel like recipients of charity.

One model, many faces

CFOs are incredibly diverse. Some are membership-based and serve specific groups; others are open to all. Some offer wraparound support like job training or help with household income; others focus purely on food. This flexibility is a strength, it not only allows CFOs to adapt to local needs, but it also makes it hard to evaluate their impact or share what works best.

"Community Food Organisations... aren’t just places to get food. They're places of dignity, connection, and hope."

A recent review led by by colleague Claire O'Malley (currently under review) found that there’s no single definition of a social supermarket. And many operate informally, relying on local relationships and community goodwill to source food. This makes them agile, but also vulnerable.

Why now?

Since the pandemic, food insecurity has increased, especially in the North. But so too has the rise of CFOs. In the North East and North Cumbria, there are now 67 social supermarkets. In the North East town of Middlesbrough alone, the number of Eco Shops, the dominant social supermarket model, has jumped from nine in 2021 to 28 in 2025.

This growth shows just how much communities value these spaces. But it also raises urgent questions:

• How can we make these models sustainable?
• What support do they need to thrive?
• How do they fit into the bigger picture of public health and food policy?

Why the Child of the North report matters

Including CFOs in the report will:

• Raise national awareness of their role and potential.
• Create shared definitions and standards to help evaluate impact.
• Highlight best practices and support scaling of successful models.
• Ensure CFOs are recognised as part of the wider food and health system - not just a stopgap.

This isn’t just about food. It’s about fairness, dignity, and giving communities the tools they need to support themselves. CFOs are already making a difference. With the right recognition and support, they could transform community support with accessible, socially accessible methods of community aid.

About the authors:

Andrea Burrows is a Research Associate at Teesside University and a Fuse Associate member

Dr Claire O'Malley is a Research Associate at Teesside University and a Fuse Associate member

Helen Moore is an Associate Professor at Teesside University and a Fuse Associate member

Amelia Lake is Professor of Public Health Nutrition at Teesside University, Deputy Director of Fuse, the Centre for Translational Research in Public Health, a dietitian and public health nutritionist.

"We cannot afford to wait" - a call to prioritise support for people living with severe mental ill-health

Posted by Dan Steward, Research Assistant at Newcastle University, and the WHOLE-SMI Community Advisory Group and research team, for Mental Health Awareness Week

Fuse colleagues advocating the words of public contributors in mental health research

People living with severe mental ill-health (SMI) often face profound inequalities in both their physical and mental health - and the systems designed to support them are not always equipped to meet their complex needs. That is why we launched WHOLE-SMI (Wellbeing and HOListic health promotion for people with Severe Mental Illness), a programme of research led by Fuse researchers at Newcastle University, focused on understanding how services can better support the whole health of people living with SMI.

Our work set out to answer a vital question: How can we use the resources we already have to do more for those who need it most?

To find out, we engaged with a wide range of voices across the North of England: people with lived experience of SMI, those who commission services, GPs, and frontline staff. We wanted to understand what support is currently available, what the biggest challenges are in accessing it, and how services could be improved. This collaborative approach gave us deep insights into what is working and where real change is urgently needed.

At the heart of our project was a community advisory group made up of individuals with lived experience of SMI. This group worked alongside us from start to finish. They helped shape our questions, guide our focus, and ensure the findings reflected what really matters. Their input was not just advisory - it was transformational.

Together, we identified the most important messages from the research and created clear, compelling headlines to communicate them. We also co-wrote a letter to Prime Minister Sir Keir Starmer, urging the new government to take immediate action. With the recent announcement that NHS England will be abolished, we believe this moment is critical. There is a unique opportunity to rethink how health services work for people with severe mental ill-health, and we must not let it pass us by.

"We need you to be an advocate for those living with poor mental health and be compassionate and vocal in committing to service improvements." 

                                                          Quote from the letter to Prime Minister Sir Keir Starmer

We share our open letter respectfully, but with urgency. Too often, people with SMI are overlooked or underserved. They deserve care that supports all aspects of their health: physical, mental, emotional, and social. We hope this work sparks meaningful dialogue and real change in how services are designed and delivered.

Please read more about the WHOLE-SMI programme and access our findings here.

If you would like to get in touch, please contact Professor Emily Oliver.

Because no one should have to wait for the support they deserve.

Read the full letter below

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

How our ‘test & learn’ prototypes are strengthening Social Prescribing

Posted by Ang Broadbridge, Head of Implementation at Ways to Wellness, on #SocialPrescribingDay

Evaluation is often something that happens at the end of a project, but what if we built learning into the process from the very start?

At Newcastle-based charity Ways to Wellness, we believe that embedding a culture of learning from the outset helps social prescribing link workers share real-time insights, refine approaches, and ultimately improve support for the communities we serve.

One area where this model has been used is in maternal mental health

Co-designing for impact

A core part of our work is connecting with local communities to shape and refine prototypes that align with our mission:

• Improving health and wellbeing
• Tackling health inequalities
• Reducing demand on NHS services

To ensure our link workers could share learning, develop key messages, and highlight gaps in services, we adopted the Learning Communities model. As described in the Learning Communities Handbook, these are:

"A group of peers who come together in a safe space to reflect and share their judgements and uncertainties about their practice and to share ideas or experiences to collectively improve."

To embed this approach into recruitment and training, we:

• Included an expectation for link workers to actively engage in Learning Communities
• Encouraged participation in ‘test and learn’ approaches
• Provided ongoing support and facilitation to foster a sense of ownership and belonging.

This approach helped link workers collaborate across different host organisations, spanning locations across the North East and North Cumbria.

Extending learning into maternal mental health

One area where this model has been used is in maternal mental health. After eight months of Learning Community meetings, we expanded this approach through a series of external learning events. These events:

• Shared early insights from our maternal mental health prototypes
• Brought in new partners to co-develop next steps
• Strengthened cross-sector collaboration

A key learning was that while social prescribing is well known in GP practices, it was midwives and health visitors who played a crucial role in referring parents to our prototypes - roles that hadn’t previously collaborated with link workers.

By opening up new referral pathways, we helped develop best practices for integrating link workers into maternal healthcare settings.

Turning insights into action

Our Learning Communities aren’t just discussion spaces - they drive change. Link workers use them to:

• Identify barriers in accessing social prescribing
• Test new ways to connect people with support
• Share insights at external events and policy discussions

The impact has been tangible. For example, after testing different approaches, some link workers are now based in health appointment clinics - an innovation that has improved system-wide connectivity and access to services.

Why this approach matters

By embedding a culture of continuous learning, we are:

• Strengthening partnerships across health and care sectors
• Ensuring services are designed with communities, not just for them
• Maximising the impact of social prescribing

At Ways to Wellness, we believe that the voluntary sector, healthcare services, and community organisations must work together to tackle health inequalities.

That’s why we’re committed to testing, learning, and adapting - so that social prescribing continues to evolve, improve, and reach the people who need it most.

Find out more at: waystowellness.org.uk

Image credits: Ways to Wellness Limited company number: 08798423

Amplifying voices to tackle inequalities in South Asian and Muslim communities

Posted by Zeibeda Sattar, Assistant Professor in Health Policy, Northumbria University

L-R: Greta Defeyter, Humaira Khan and Zeb Sattar 

I recently had the opportunity to chair the Health Inequalities Symposium hosted by the Centre for Health and Social Equity (CHASE) at Northumbria University, in collaboration with Fuse. It was an incredible event that brought together over 100 people, including researchers, policymakers, healthcare providers, and community members, all focused on tackling the pressing health challenges facing South Asian and Muslim (SAM) communities. The main goal was clear: to find ways to bridge the gap between research and real-world impact.

The presentations were enlightening and underscored how critical it is to engage with minority communities effectively to shape public health services. Each speaker highlighted a different, but equally important, health issue impacting SAM communities. Public partner Humaira Khan, who co-chaired the symposium, pointed out that the mental health challenges facing South Asian and Muslim are often misunderstood and stigmatised. Hearing her talk about the need for culturally competent healthcare really hit home. Her words - “researchers are warriors; they don’t fight for themselves - they amplify the voices of the people” - perfectly captured why events like this matter.

“researchers are warriors; they don’t fight for themselves - they amplify the voices of the people” 

Humaira Khan, public partner

Dr Sarah Croke from the University of Manchester spoke about the language and cultural barriers that often lead to untreated health issues. This can leave community members struggling because healthcare services aren’t designed with South Asian and Muslim needs in mind. Dr Saeed Ahmed from Sunderland Royal Hospital took on the tough topic of organ donation disparities. He pointed out the harsh reality: SAM communities are in desperate need of organ transplants but are also among the least likely to donate. His call to raise awareness and educate was powerful, especially when he reminded us that one donor can change up to nine lives.

There were also discussions about everyday barriers that many of us face but rarely see addressed. Professor Defeyter from Northumbria University talked about the lack of culturally appropriate meals, like halal options, in schools. It was a reminder of how even things like food choices can create a sense of exclusion for our children and why legal changes to recognise cultural diversity are long overdue.

I found Simon Luddington’s (SearchNewcastle) presentation about the West-End Befrienders project particularly inspiring. It’s easy to forget how isolating language barriers can be and how vital social connections are for our wellbeing. Their work in bringing people together, especially in helping with access to primary care and breaking down isolation, felt like a model that should be replicated.

One of the more challenging discussions was around drug and alcohol use in our communities. Lydia Lochhead’s (Northumbria University) research laid bare the stigma that prevents so many from seeking help. It’s a tough conversation to have, but hearing about Mushtaq Dakri’s community-led approach to addiction support was a beacon of hope. They offer a holistic service - combining therapy, physical activity, and spirituality - and it’s designed by and for the SAM community. Knowing there’s a women-only support space now available shows their commitment to evolving and meeting community needs.

Fuse Associate Director Dr Floor Christie and Dr Rawand Jarrar from Sunderland University, wrapped up the day with their work on improving cancer screening uptake among Muslim women. Their workshops have reached over 260 women, and it’s encouraging to see how culturally sensitive approaches can genuinely improve health outcomes. This was a reminder of how vital it is to build services that reflect our communities.

As I reflect on the symposium, it’s clear to me that these health inequalities are not just about accessing services - they’re about how these services are designed and delivered. The urgency to address these gaps cannot be overstated. The event reinforced the need for services that truly understand and respect South Asian and Muslim communities, going beyond just offering a service to creating environments where people feel welcomed, understood, and valued.

Leaving the symposium, I felt hopeful. Change is possible, but it won’t happen without consistent engagement with our communities. Trust needs to be built, and community voices must be represented and acted upon. The gap between research and impact can be bridged if we keep pushing for culturally relevant, accessible, and respectful health services.

Plans are already in place for a follow-up symposium in November, focusing once again on the health inequalities that continue to affect SAM communities. I urge everyone to get involved. This is our chance to be part of the change and to make our voices heard in the ongoing fight for a more equitable health system. Sign-up details will be shared soon, and I hope to see more of us there - because turning these conversations into action is how we create a healthier future for all of us.