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.

Training tomorrow’s Public Health leaders: impact, innovation and prevention

Posted by Liz Morgan, Head of School for Public Health North East, NHS England

The North East Public Health Postgraduate Specialty Training Programme holds an event annually to showcase the work that has been done by trainees over the previous year. This annual showcase highlights how public health trainees in the North East are delivering practical, high‑impact work across the health and care system, demonstrating the value of prevention-led leadership at a time of increasing system pressure. It not only celebrates the tremendous work our trainees have been doing but also provides an opportunity to share that work with public health colleagues in multiple settings During this time, our trainees will have been immersed in communities, health and health-related systems and research environments, identifying challenges, designing solutions and implementing projects that demonstrate innovation and impact. The projects presented at our last meeting ranged from heath protection and health improvement to policy development and healthcare public health. Each one reflected the commitment, curiosity and compassion that defines our public health workforce.

Tackling air pollution through NHS leadership

Most NHS Trusts in the North East employ at least one public health consultant, valuing the broad benefits that this can bring, but also providing greater capacity for public health training. Dr Laura Keast had been undertaking a placement in Northumbria NHS Trust, implementing the Clean Air Hospital Framework and demonstrated the value of collaboration between public health and sustainability teams. Air pollution remains the single greatest environmental threat to public health in the UK, contributing to an estimated 30,000 deaths annually and worsening health inequalities. By making air pollution a tangible and locally relevant issue through accessible monitoring of nitrogen dioxide levels and clear health messaging, the initiative has generated engagement and momentum for action. Importantly, the project highlighted that public health leadership, data expertise, powerful health messaging and alignment with national policy levers are critical in overcoming uncertainty and organisational resistance to change.

Reducing missed outpatient appointments for children

Dr Mark Riley presented a service evaluation undertaken at South Tees NHS Trust exploring why children are not brought to outpatient appointments, an issue with significant implications for health outcomes and system efficiency. Using surveys and follow-up telephone calls, the evaluation identified five key themes:

• appointment timing
• forgotten appointments and reminders
• administrative barriers
• health literacy
• cost of attendance.

Forgotten appointments were the most common reason for non-attendance, with parents strongly favouring clearer and more frequent text reminders. Difficulties rearranging appointments, confusing letters and limited awareness of travel cost reimbursement schemes further contributed to missed care. The findings underscore how relatively small, system-level changes, such as health-literate communications in multiple languages and flexible appointment scheduling to include evenings, can reduce inequalities and improve service use. Finding a champion in the organisation to enable change was also critical.

How leaders make difficult priority-setting decisions

As pressures on the NHS intensify, difficult decisions about how to allocate limited resources are unavoidable. Dr Tom Seasman explored how senior health leaders justified priority-setting decisions. Qualitative in‑depth interviews with leaders across the English health system show broad support for prevention and reducing health inequalities. However, when faced with real-world trade-offs, decisions often favour short-term frontline clinical care over long-term preventative investment and leaders differ in their responses. Clinical leaders often prioritise immediate need and the “rule of rescue”, while those approaching the same problem from a public health perspective place greater emphasis on maximising population health gains through prevention. Political constraints, emotional proximity to patients and fragmented funding structures frequently limit leaders’ ability to shift resources from acute care to prevention, despite widespread recognition that long-term sustainability depends on doing so. These findings raise important questions about how the health system can better support leaders to make transparent and ethical trade-offs.

Policing and public health: prevention in action

Prevention also featured strongly in work exploring collaboration between policing and public health. This is important because of shared commitments to improve lives, reduce harm, reduce unnecessary demand on services, reduce vulnerability, improve equity and maintain public trust. Since the publication of a national consensus statement in 2018, prevention has become more explicitly embedded within policing policy and inspection frameworks. A 2025 review concluded that, while the original vision remained relevant, a refreshed consensus was needed to reflect current challenges and language. Kylie Murrell led on this national project, chairing the policing and public health collaborative, leading on the re-drafting of the document and sign off and associated ministerial briefing. The work highlights both the appetite within policing to engage more fully in prevention and the ongoing need for public health professionals to support cross-sector partners to identify upstream opportunities to reduce harm, vulnerability and demand. It's also an excellent example of how our trainees have led on national initiatives.

Supporting wellbeing within the public health workforce

Alongside the ongoing system-level challenges, attention to the wellbeing of the public health workforce itself is increasingly recognised as essential. Vineeta O’Key reflected on the work the trainees had been doing to support their own wellbeing and on how a Wellbeing Away Day could demonstrate how evidence-based wellbeing approaches could be embedded within training and professional development. Grounded in the “Five Ways to Wellbeing”, the day prioritised connection, learning, physical activity and engagement with nature through volunteering with Durham Wildlife Trust. Feedback highlighted the value of protected time for relationship-building, reflection and compassionate leadership, reinforcing the role of wellbeing as both a personal and professional competency in public health practice.

Julie Lowe presented her experience of travelling to Canada and the Netherlands on a Churchill Foundation fellowship. The Foundation funds approximately 100 Fellows each year to travel overseas to explore an issue of societal importance. This project focused on community interventions to improve the health and wellbeing of unpaid caregivers, who, as a population, experience poorer mental and physical health outcomes known informally as the ‘carer burden’. She shared reflections from her own experience as a young carer and motivation for choosing a career in public health. Findings from her experience included the importance of listening to diverse groups of carers to understand their needs and preferences, and the need for interventions that reduce carer burden rather than responding to health needs as they arise.

Taken together, these projects reflect a common theme: public health impact is maximised through leadership, collaboration and a commitment to prevention, even in constrained systems. Our trainees are already having an impact in their placements and communities by shaping national priorities, supporting workforce wellbeing and building partnerships beyond health. Creating spaces like this conference where recent projects and ideas can be shared, and challenges are explored are vital and demonstrates how public health continues to be pivotal in navigating complexity and working towards more equitable and sustainable futures. I would strongly encourage all of our public educators and senior public health colleagues to attend this event. As Public Health influencers, the task of considering, adapting and altering these ideas and interventions for the benefit of the populations we serve rests with us.

Changing the narrative on gambling harms in the North East

Posted by Dr Andrew Richardson - Research Associate (Gambling Harms), Newcastle University; Alice Beadle, Public Health Specialist - Gambling Harms, Middlesbrough Council; and Laura Sheridan, Public Health Officer – Gambling Harms, Middlesbrough Council

Gambling is staking money, or something of value, on the outcome of something involving chance. Gambling activities can include arcades, esports and video games, betting shops, online betting, gaming machines, lotteries, bingo, casinos and other common types of gambling. Gambling harms affect thousands of people across England but the North East faces the greatest risk. National estimates suggest that 3.8% of people are at elevated risk from gambling. In the North East, that figure rises to nearly 5% of people aged 16 and over - the highest rate of at-risk gambling in the country. These people experience a range of negative consequences, from financial hardship to serious mental health challenges.

To explore the scale and impact of gambling harms in the region, read the Regional Health Needs Assessment for Gambling.

What are gambling harms?

Gambling harms are any negative consequence or side effect experienced because of gambling. They may be felt by the person who is gambling or may be experienced by those close to them, such as a family member, friend or colleague, known as ‘affected others’. For each person who experiences gambling harm, on average six others are affected - often partners and children.

Whilst anyone can be harmed by gambling, it does not affect everyone equally. The harms from gambling are varied and may also be interconnected. They include:

• Increased stress and poor mental health (such as anxiety, depression and suicide risk).
• Financial hardship, debt, asset loss and bankruptcy.
• Relationship breakdowns due to increased conflict, issues with trust and stress associated with harmful gambling. There are also links between gambling and domestic violence.
• Reduced performance and absenteeism in education and in the workplace.
• Stigma and shame associated with gambling behaviour.
• Threatening behaviour, damage to property, fraud and theft.

For many, gambling harms leave a legacy and may be experienced for many years after the event.

A public health approach

The Association of Directors of Public Health in the North East (ADPH NE) Gambling Harms Programme aims to tackle the harm caused by gambling in the North East with a coordinated regional approach. The Programme received funding that originally came from a gambling operators’ penalty but was redirected by the Gambling Commission - called a ‘regulatory settlement’.

Gambling harms are complex, and prevention approaches need to move away from ‘personal responsibility’ to population-wide social, economic and environmental interventions. Messaging from the gambling industry often sets the narrative by placing responsibility onto the individual to address harmful gambling, despite the many ways gambling products are designed to be addictive. This can lead to increased stigma and shame and create additional barriers to help-seeking behaviour.

The Regional Office, a team hosted by Middlesbrough Council, supports the 12 Local Authorities in the North East to pilot prevention approaches to help reduce gambling harms. The Programme has developed resources which include awareness raising materials and evidence summaries to support practitioners in local authority settings.

Eight key priority areas have been established under the Regional Office:

1. Support and Partnerships – Responding to requests from local authorities and wider stakeholders to support understanding of gambling harms and embed prevention activity.

2. Advocacy – Contributing to the shaping of policy at a local, regional and national level by promoting a public health approach to support those impacted by gambling harms and to build an environment that prevents future harm.

3. Media, Communications and Education – Raising awareness of gambling harms and aiming to reduce stigma.

4. Treatment – Promoting regional treatment services and referral routes for residents and professionals across the North East of England.

5. Data, Research and Evaluation – Develop and create evidence bespoke to the North East and contribute literature to the national evidence base regarding gambling harms.

6. Licensing – Supporting planning and licensing colleagues to create environments that prevent future gambling harms.

7. Protecting Young People – Recognising the risks of gambling to children and young people, and developing resources to support caregivers to reduce risks of gambling harms.

8. Lived Experience – Co-producing all outputs with the Lived Experience Forum, made up of members from across the Region. This ensures all outputs reflect real-world experiences and have maximum impact.

To learn more about gambling and gambling harms, please use the ADPH NE Gambling Harms slide deck or access free Making Every Contact Count (MECC) and Gambling Harms training here.

You may also be interested in these national resources:

• Local Government Association (LGA): Tackling gambling related harm: A whole council approach.
• National Institute for Health and Care Excellence (NICE): Gambling-related Harms: Identification, Assessment and Management.
• OHID Gambling treatment and support in England: main findings and methodology.
• Gambling Commission Young People and Gambling report.

Learning from others

The North East Programme was inspired by the Greater Manchester Combined Authority and ADPH Yorkshire and the Humber to share findings and best practice. The three regional programmes collaborated on a Language Guide to promote language choices that reduces the stigma associated with gambling.

Building the evidence

The Programme will be evaluated and this will contribute to the evidence base on actions to reduce gambling harms, which is currently dominated by gambling industry narratives. The team is working with local partners to explore the wide range of healthcare services and practitioners who may be in contact with gamblers or people affected by gambling and educational toolkits for schools and communities etc. To learn more, see this academic paper co-authored by Fuse researchers or view a free slide deck that summarises the latest research on gambling harms.

Lived experience

The Programme also facilitates a Lived Experience Forum to help shape work happening across the region. If you have experienced gambling harms, either directly or as an ‘affected other’ and are based in or from the North East, this is open to you. If you would like to influence the work being done to tackle gambling harms in the region, please email GHR@middlesbrough.gov.uk.

Stay in the loop

The ADPH NE Gambling Harms newsletter includes news about events, new research, resources like podcasts and documentaries, and ways to get involved. Join the newsletter mailing list by contacting GHR@middlesbrough.gov.uk or complete the sign-up form here. New resources can also be found on the ADPH NE Gambling Harms website.

Treatment and support

Visit the Gambling Harms MECC page to find treatment, support and blocking tools. For some people in recovery from gambling harms, treatment may be the best option, whereas peer support groups may be better for others. Professionals can refer directly into these services. This may make it easier for those needing treatment and support to take the first step on their recovery journey.

Photo by Michele Lana on Unsplash

What did you eat yesterday? The messy science of measuring what we eat

Posted by Dr Kath Roberts, Senior Lecturer in Public Health Nutrition, University of York

Ask anyone what they ate yesterday and you’ll likely get a pause, a guess, and maybe a laugh. That’s the reality nutritional epidemiologists (scientists who study how diet affects people’s health) work with every day. Measuring what people eat sounds straightforward but is surprisingly complex. And yet, understanding dietary intake is central to advancing nutrition science, improving public health, and shaping government dietary guidelines.

Increasingly, attention is turning not just to what people eat, but how well they eat overall. The concept of diet quality, looking at the overall balance, variety, and healthfulness of the diet has become a cornerstone of nutrition research. It also offers a way to bring together fragmented messages about nutrients, food groups, ultra-processed foods and national guidelines into one meaningful measure. But defining and measuring diet quality is just as tricky as tracking individual foods.

This blog reflects on the practical and scientific challenges of defining, collecting, analysing and interpreting dietary data and reflects on how improvements in methods and technology are shaping the future of dietary data.

Why measuring diet is so difficult

Capturing dietary intake data involves a tangle of practical and methodological problems. First, there’s the human element. People often don’t remember exactly what they ate or may selectively forget. This recall bias is especially tricky with foods eaten on the go or in small amounts. Then there’s social desirability bias. People want to give the “right” answers, especially if being questioned by an actual human (as opposed to filling out a diary or survey). So while a few honest folk might confess to having a chocolate bar for breakfast and a midweek takeaway, many prefer to report kale and quinoa - or at least a committed adherence to the holy ‘five-a-day’ grail. The result? A gap between what people say they eat and reality.

Then there’s the issue of burden. Some methods, like weighed food diaries, ask a lot of participants. Accurately weighing and logging every bite is time-consuming and often tedious. It may even change behaviour just to make recording easier. My own experience some years ago with logging foods through a free and widely used app was that it made me lean towards buying and consuming processed foods that I could just scan the barcode of, rather than cooking from scratch or shoving whatever was in the fridge onto a plate as I usually would. Other methods like food frequency questionnaires (FFQs) and 24-hour recalls try to reduce this burden but come with their own compromises.

Tools of the trade: strengths, weaknesses, and trade-offs

FFQs remain popular in large epidemiological studies because they’re cost-effective and can capture habitual intake over time. However, they rely on memory and a fixed list of foods that might not reflect cultural or personal variation, only capturing, by design, data on what they ask about. 24-hour recalls offer more flexibility and less reliance on long-term memory, especially when conducted with structured prompts like the USDA's multiple-pass method. But they only capture a snapshot in time and one day rarely reflects the whole story. Diaries, whether weighed or estimated, provide rich detail but at a cost. They demand motivation, literacy, and a willingness to record every meal, snack, and nibble without altering usual habits.

Brief screeners, like the US Healthy Eating Index or dietary diversity scores, offer pragmatic options for surveys or interventions. They’re easier to administer and analyse, but they tend to gloss over the nuance of full dietary patterns. And they still face questions of sensitivity and specificity - are they really measuring what matters most for health?

So what is a healthy diet anyway?

Amidst the tangle of dietary data collection challenges, there is the important question of ‘what is a healthy diet’? This is where the idea of diet quality comes in. Rather than counting single nutrients or fixating on particular foods or food groups, diet quality looks at the whole picture: how balanced, varied, and aligned with health guidelines someone’s overall eating pattern is. It’s become a cornerstone of nutrition science and epidemiology, but it’s surprisingly hard to pin down and turn into a clear, usable measure for research.

This also matters for public health messaging. People are bombarded with a range of different messages. We have the NHS Eatwell Guide, the High Fat Salt Sugar (HFSS) advertising restrictions, front-of-pack nutrition labelling, SACN Dietary Reference Values, rising concerns about ‘ultra-processed foods’ - and these don’t always line up. Each of these frameworks is based on different criteria and assumptions; food-based, nutrient-based, processing-based - which can send mixed messages and make public health advice feel inconsistent or overwhelming. Without a consistent definition of what a ‘healthy diet’ looks like, it’s easy to get confused.

That’s why the idea of diet quality is so powerful: it can provide a coherent construct that integrates these strands and translates complex nutritional science into something more intuitive and holistic. But the reality of defining and measuring diet quality is messy. Efforts like the UK-DQQ show promise, offering a simple, food-based screener aligned with national guidance, derived from empirical dietary patterns and validated against both biomarkers (e.g. blood and urine) and nutrient intakes. But even this needs updating as dietary trends evolve and must be validated in diverse population groups.

The trouble with comparing apples to oranges (or diet scores to diet scores)

No universal agreement on how to define a ‘healthy diet’ contributes to variation between studies, making it hard to compare results or synthesise evidence. Some researchers focus on diet quality scores (like HEI), others on dietary diversity, others on adherence to national guidelines or cultural patterns like the Mediterranean diet. These varied definitions mean that two studies can report on ‘diet quality’ but be talking about quite different things.

The Mediterranean Diet Index and its adaptations, such as the relative Mediterranean Diet Score or alternate Mediterranean Diet Score, are widely used in Europe. These scores capture core elements of Mediterranean dietary patterns: a lot of vegetables, pulses, fruits, nuts, olive oil and fish; moderate alcohol drinking; and low amount of red meat and dairy. In countries like Spain, Italy and Greece, these tools have helped characterise regional diets and assess traditional dietary patterns in relation to cardiovascular disease, cancer, and overall death rate.

European examples such as the EPIC cohort (European Prospective Investigation into Cancer and Nutrition) show how differing dietary patterns and assessment methods between countries can complicate analyses. EPIC responded by conducting extra studies to adjust for differences in how diets were measured across countries.

The cost of precision

Gold-standard methods like weighed food diaries or duplicate meals offer unmatched detail, but they’re expensive, burdensome, and often impractical for large groups. Even with trained coders and food composition databases, analysis is slow and complex. Participants may forget to record, misestimate, or change how they eat.

And food diaries only capture a few days raising the question: are those days typical? People might eat differently on weekends, holidays, or when they’re sick. So we need multiple days, and sometimes biomarkers or repeat measures, to estimate what is usual. That’s time and resource intensive. And even then, we must account for people who report eating less than they actually do.

In the UK, the National Diet and Nutrition Survey switched from 7-day weighed diaries to 4-day estimated ones, to computerised 24 hour recall methods. These changes reflect the challenge of balancing accuracy, rigour, realism and resource constraints.

From challenge to opportunity: smarter tools, better insight

The good news? We’re getting better. Digital tools like Intake24, MyFood24 and ASA24 allow self-administered, online 24 hour recalls with built-in prompts, portion images, and food databases. These tools reduce burden and standardise data collection. AI is also being explored for recognising foods from images, helping reduce reliance on memory and self-reporting.

Dietary pattern analysis is also on the rise. Rather than fixating on individual nutrients, researchers are looking at how foods cluster together using tools like principal component analysis. These approaches acknowledge that we eat meals, not molecules and that whole-diet patterns may offer a more stable and interpretable link to people’s health.

What now?

Dietary data collection isn’t perfect and may never be. But it’s getting better. By balancing scientific rigour with practical constraints, and by using emerging technologies and analytic strategies, researchers can produce meaningful insights. Whether it’s via smarter recalls, better biomarkers, or dietary pattern-based analysis, the goal is the same: to understand how what we eat affects our health and how we live. That journey starts with listening carefully, thoughtfully, and with an appreciation for just how tricky it is to answer the simple question: “What did you eat yesterday?”

So the next time you try to recall what you ate yesterday, remember you're not alone - even science is still figuring it out!

“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.

Understanding the ‘zoppie buzz’ in Teesside

Posted by Hannah Poulter, Teesside University, Visiting Research Associate, University of Bristol

Hannah's post coincides with International Harm Reduction Day, which is observed each year on 7 May and is dedicated to harm reduction approach to drug addiction.

At the conclusion of our research into Heroin Assisted Treatment (HAT) in the North East of England, so many questions remained for me, one of which was: What’s with the zoppie (zopiclone) ‘buzz’ in Teesside?

Teesside gets quite a bad reputation when it comes to drug and alcohol use, which perhaps isn’t surprising when you consider in Middlesbrough you’re more likely to die from a drug related death than a car crash. What we don’t often hear about is the ongoing innovative and groundbreaking work to create solutions to complex problems such as those spanning multiple public budgets - health, justice and social care.

Through our research on HAT we got an insight into the havoc caused by street tablets (such as zopiclone) in Middlesbrough, a story also found in other places within Teesside and further afield. Street tablets are defined as illicitly manufactured prescription-like tablets (that look similar to prescription medication in packaging) bought from illicit sources (street dealers) and used without medical advice.

The prevalence and availability of street tablets here, such as zopiclone, combined with their adverse health consequences and impact on treatment engagement makes a rather toxic combination of risk factors for people who are already vulnerable. I feel empathy for both the marginalised people struggling with their addiction to street tablets (amongst other substances), who felt that there was no feasible offer of treatment for them and the healthcare practitioners tasked to support them, with little advice to draw upon beyond ‘don’t take them’.

While we found there were pockets of great work being undertaken, we also saw that the work wasn’t particularly joined up and that there were lots of gaps in knowledge:

• What was the appeal of zopiclone in Teesside, a seemingly unique feature of the local drug market here?
• What do people who use street tablets think could be done to help improve treatment?
• How could we increase knowledge, collaboration and capacity between local practitioners, academics, people with lived experience and the police to address this public health issue together?

As an Early Career Researcher with a ‘non-standard’ research career (I had a career in business development, research and policy in the housing sector prior to re-entering higher education), I was both confident and daunted by the prospect of leading a project in this area.

Confident because I was sure I could achieve this as I had led on, and been part of many projects focused on collaboration, capacity development and research in the past. Daunted because this was one of the first projects I had led in my own research area as an academic, and I wanted to prove that I was able to do so alongside delivering academic outputs and impact.

I feel proud and relieved now this project is over and am incredibly delighted that we delivered extra value for the funders alongside some solid impactful work in this important area. Here’s a summary of our work:

Engaging people who are often less well represented in research and involving them in the process and co-production of solutions to addressing street tablet use.

One workstream of this project used Community Based Participatory Research with a lived experience researcher, Peter DaSilva from Recovery Connections. With Peter’s knowledge of the local drug market, operating context, and behavioural factors we were able to engage some of the most marginalised people at risk of a drug related death into the research process.

I am so passionate about lived experience recovery organisations and their crucial work using lived experience to engage and retain people in treatment. We have a publication on this currently under review with the Harm Reduction Journal.

Understanding the harms associated with zopiclone use and unique features of the zopiclone market in Teesside.

Several smaller spin off projects have been developed as a result of this grant. We delivered two student projects which involved speaking to healthcare practitioners (HCPs) in Teesside about their perceptions of street tablet usage. I’m currently working with Dr Jenny Scott at the University of Bristol to combine our data with a larger multi-site project on HCP insights, funded by the Economic and Social Research Council. To support the completion of my Stage 2 Doctorate in Health Psychology I’m conducting a rapid review of the existing evidence base on zopiclone. Another paper we have nearly completed is one analysing prescription rates to understand how changes to safe prescription of zopiclone may be associated with the illicit market. Through this portfolio of work we will have a much better understanding of the unique features of the zopiclone market in Teesside.

Developing ways to share information and access better technology within Teesside for real-time testing to help reduce harms and overdose risk for people who use drugs.

Key relationships and mechanisms of information sharing have been built, improved and solidified through this project. Dr Gillian Taylor (Teesside University) has been testing locally seized samples such as zopiclone and pregabalin to improve local knowledge sharing. Gillian and I have worked with Joanne Russell from Public Health South Tees supporting their establishment of the Local Drug Information System in Middlesbrough such as the standard operating procedure. Dr Taylor is now sharing testing information of locally seized samples to supplement local overdose alerts and has a formal relationship with Cleveland Police which she has developed as a result of engaging on this project.

Better knowledge exchange between academics, practitioners, and policy makers locally, regionally and nationally.

Local regional and national connections were key ingredients to this project and have led to knowledge exchange beyond the remits of this funding stream. The connection which has personally stood out for me, has been with the team at University of Bristol, led by Professor Graeme Henderson, Professor Matt Hickman and Dr Jo Kesten. Through engaging with them on this project, I was appointed as Senior Qualitative Researcher within the School of Clinical Epidemiology and Public Health at Bristol between September 2022 and March 2024 on their project: Opioid overdose deaths: Understanding the lethal interactions between benzodiazepines and opioids to develop new harm reduction strategies funded by the Medical Research Council. I have learned so much from working on this project, and from my colleagues, which I hope will lead to other projects in the future. We are currently writing up the outputs from our qualitative work, have presented our findings at the Society for the Study of Addiction conference in 2023 and our team presented our work at the European Conference on Addictive Behaviours and Dependencies in Lisbon in October 2024.

Where next?

Now this project is over, (and following me being on maternity leave for a year), we are working on writing up the key outputs from our work. Our ultimate goal is to improve the offer of care for people who use drugs in Teesside and beyond.

What I’ve learned from this project is that we can only do work of this nature, with the right funding, and right support from senior members of Teesside University and local decision makers. Having the funding to support me to completely dedicate one day a week to capacity building enabled by the Targeting Health Needs grant from NIHR Clinical Research Network, gave me brain space from my busy role within the Evaluation and Impact Team, was transformational. It takes time to create good quality dedicated multidisciplinary and translational research, and often the intangible but important factors in this process such as ‘connection building’ can take the most time.

The Heroin Assisted Treatment (HAT) study was funded by the National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC)

Targeting Health Needs project funded by National Institute of Health and Care Research [NIHR] 2022/23 Clinical Research Network (ref: 17969707). 

Over the rainbow: research with an intersectional perspective

Posted by Dr Mark Adley, Research Associate, Newcastle University

• LGBTQ+ is an abbreviation for lesbian, gay, bisexual, transgender, queer or questioning, with the "+" sign recognising the multiple permutations of sexual orientation and gender identity.

• Intersectionality looks at how social inequities such as racism, sexism, or classism can interact and shape people’s social experiences.

"Reaching Out", pencil and pen drawing and digital collage by artist Sarah Li (2024)

In this Question and Answer blog, Mark shares some of his reflections on intersectionality when working with marginalised groups, and the importance of taking extra steps to make sure that the quieter voices are also heard. LGBTQ+ people are not a single group, and sexism, racism, classism and other social inequities can create unexpected intersections.

What was the focus of your PhD research project?
My PhD examined marginalisation in health and social care services in North East England, specifically looking at multiply marginalised LGBTQ+ people – those who had faced additional experiences of, for example, homelessness, substance use, racism, or domestic abuse. Seventy-two people across the region took part in interviews – 33 with professionals and 39 with marginalised LGBTQ+ people.

How would you explain intersectionality to someone new to the concept?
The shortest explanation would be that 1+1 does not equal 2. Intersectionality examines how different aspects of our identities can interact – creating unique experiences of discrimination. For example, a Black woman's experience isn't simply the addition of being Black plus being a woman. She may experience racism differently than a Black man, and she may experience sexism differently than a White woman. Her experiences as a Black woman are a unique intersection of race and gender. As Zora Neale Hurston perfectly captured in 1928: ‘I feel most coloured when I am thrown against a sharp white background’.

What challenges did you face in participant recruitment?
One major challenge was ensuring diverse representation. I noticed early on that lesbians and bisexual women were underrepresented, so I paused recruitment to address this. This led to an unexpected complexity – navigating the cultural and political debates around gender identity, particularly around use of the word ‘woman’ – and how to distinguish between cisgender and transgender women without causing offence.

How did you handle the sensitive terminology around gender identity?

It required extensive consultation with five women who held different perspectives on this issue. We eventually reached what I'd call a diplomatic compromise on language – while no one was completely satisfied, no one was seriously offended either. This highlighted the importance of careful navigation in sensitive cultural debates.

Recruitment flyers for lesbian, bi, queer, and pansexual women (left) and LGBTQ+ people of colour (right)

What adjustments did you make to ensure racial diversity in your study?

By March 2023 I had interviewed nine LGBTQ+ people from non-White British backgrounds, but only six were from non-White ethnic groups. After reflecting on the specific experiences of discrimination and invisibility shared by LGBTQ+ people of colour, I paused recruitment again. Following consultation with queer people from ethnically minoritised groups we rebranded the study, including removing rainbow imagery in favour of a brown background, as the rainbow was perceived as ‘very White-presenting’.

What key lessons did you learn about conducting research with an intersectional perspective?
The research required a constant shift in my own focus as a researcher. First, looking inward through reflexivity – examining my own unchecked biases and assumptions and their impact on how the study was conducted. Second, looking outward to understand the broader systems of power that influenced people’s experiences of marginalisation. It's a complex balance that requires both zooming in and out, while avoiding what has been called the ‘fetishization of complexity’.

The study’s key findings and recommendations

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Findings from the study are available in several formats

PDFs can be downloaded from the project’s website, with videos on YouTube and an Open Access scoping review published in BMC Health Services Research. Mark is involved in ongoing work exploring the experiences of LGBTQ+ people of colour, and collaborations with local organisations in consideration of intersectionality across the North East and Cumbria. To contact Mark or receive project updates via the mailing list click here.
-----------------------------------------------------------------------------------------------------------------------------------------------------------------


This study was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Bringing dietetics into Public Health

Posted by Alex O'Connor-Sherlock, MSc Dietetic student, Teesside University.

Introduction by Steph Sloan, Senior Lecturer in Dietetics and Course Leader MSc Dietetics at Teesside University.

Practice-based learning (PBL) is a key part of dietetic training, with students required to complete 1,000 hours of hands-on experience in a practice setting. Traditionally, this has mostly taken place in NHS settings, with students working one-on-one with supervisors. However, as healthcare demands grow, diversifying placement opportunities is becoming increasingly important - not just to support student learning, but also to strengthen public health initiatives.

Suited and booted to present to a factory workforce

The Allied Health Professions (AHP) Strategy for England highlights the role of AHPs in disease prevention and health promotion, helping to reduce the burden on already stretched health and social care services. Diet-related diseases remain a major public health challenge, yet dietetic care is still largely focused on treatment rather than prevention. If the profession is to play a greater role in supporting population health, then equipping students with strong public health knowledge and skills is crucial.

To support this, Teesside University’s MSc Dietetics programme now includes public health placements alongside traditional NHS clinical placements. Here, Alex shares her experience of working in a Public Health practice-based learning setting. A must read in National Careers Week for anyone considering a future career as a dietitian!

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

What I worked on

During my placement, I was involved in three projects focused on health improvement and disease prevention. My work involved meeting with stakeholders, conducting research, presenting findings, and engaging with the public. The projects covered a wide range of population groups, including expectant mothers, school-age children, local workforces, and food bank users.

1. Supporting parents with child nutrition

A key part of my placement involved reviewing the nutrition education available to parents of children aged six months to four years.

What I did:

• Conducted a literature and policy review
• Spoke to parents, NHS staff, and school representatives
• Attended a breastfeeding class to hear directly from parents
• Presented my findings to several teams, including the Director of Public Health

Why it matters:

The insights from this work will help shape future research and improve nutrition support for families in the local area.

2. Linking oral health and nutrition

There is a strong connection between what we eat and oral health, but not everyone has access to clear, easy-to-understand information about this link.

What I created:

• Infographics and presentations to educate local workforces
• Materials designed in an easy-read format, avoiding jargon

Why it matters: 

My presentation was really well received, and I was even asked to record it for wider distribution, so it could be shared with professionals working with children and people with additional needs.

 

Infographics to educate local workforces

3. Reducing food waste in a local food pantry

Many food pantry users rely on short-dated products, and without clear guidance, a lot of good food can go to waste.

What I did:

• Designed simple, visual signs with food storage and cooking tips (e.g. "Chop me then freeze me")
• Introduced a ‘Freeze me’ sign for bread and monitored its impact

What happened?

Twice as much bread was sold the day after the sign was put up compared to the previous two weeks combined!

Signs made to reduce food waste

What I learned

• Public health plays a key role in patient care - I saw first-hand how wider social factors impact people’s ability to manage their health and access services.
• Being proactive is crucial - I reached out to stakeholders independently, which helped me build confidence and leadership skills.
• Flexibility is a great learning experience - managing my own projects and working in a less structured environment improved my time management and adaptability.
• Self-care matters - the flexibility of this placement meant I could work in different settings, including from the park on sunny days!

Final thoughts

Introducing dietetic placements into public health settings is a win-win. It helps students gain a broader skillset, supports NHS capacity, and brings dietetic expertise into community settings.

Of course, doing things differently comes with challenges. Expanding placements into public health settings has required commitment from everyone involved - academics, placement providers, and students. But we’re constantly learning and improving, and we’re proud to be making a real impact on the health of our local communities.

Animating practitioners to take action on stigma

Matty Starforth, Public Health Practitioner-Harm Reduction and Social Inclusion Portfolio, Newcastle City Council

“Stigma, stated simply, is a set of negative and often unfair beliefs. Stigma can be experienced on a societal, structural and personal level. It is employed largely unconsciously but at times also consciously”. 

Anti Stigma Network

Stigma is often a word that is associated with harm but it is important to recognise that stigma can have a huge impact on individuals and groups in society. From my own professional experiences, I am aware, like many of my colleagues and partner services are, that the harms of stigma can include and are associated with inequality, disadvantage, discrimination. Stigma increases stress, shame, depression, isolation, and can lead to the avoidance of healthcare and decreases treatment engagement and retention for individuals and groups.

 

It’s clear that there is a need to address stigma and embed an ‘anti stigma approach’ as part of the work we do to tackle inequalities, but doing so can be challenging. While people tend to be generally aware of the term stigma and how this can affect individuals, there is often less understanding of the depths that people go through to avoid and overcome the stigma they experience, such as not attending appointments or seeking the help or support they deserve. There is also less awareness of the steps that we can all take as individuals to not only avoid stigmatising people through our language and practices, but also actively speak out and promote an anti-stigma approach more widely.

What we are doing about it

To address this, we have had several areas of work in Newcastle upon Tyne looking to raise awareness and address some of the harms of stigma on others. This started with the publication of Drugs, Identity and Stigma and ongoing discussions about changing how we focus on people who use drugs or alcohol and the language we use for those facing multiple disadvantage and exploitation. Academics, policy makers, public health and key stakeholders, from working together on various research, came together to deliver a practitioner conference, improve practitioner training, development and networking and production of a practice briefing, stigma animation and a planned education package. All of this has been informed by lived experience.

In May 2023 we worked with partners to hold a conference to over 320 practitioners, service providers and community members from across the region. The Stigma, Trauma, Substance Use and Domestic Violence Conference involved a range of international, national and regional researchers and academics including a keynote talk from international anti-stigma lead, Professor Carla Treloar. The Conference was designed to promote knowledge exchange and good practice of Anti-Stigma work from across the region. A practice briefing that was developed from the event can be found here. A key theme in the discussions has been around vulnerability and exploitation, and partners have worked together, from research developed by the University, to produce animations around exploitation and home takeover. Research into practice improvement. Two artists were employed to capture the key themes and discussions of the conference as a visual (see below) which could then be shared with services.

Visual capturing the key themes and discussions of the conference

Developing the stigma animation

From this work, we explored how we can explain the ongoing theme of stigma and its impact. A recent project that I have coordinated, in collaboration with university colleagues, is the production of a stigma animation which you can see above. Aimed at practitioners and volunteers, this will help raise awareness and become a key resource to support the work and objectives we have within Newcastle Public health, and also the wider local authority. The animation has involved consultation and input from a range practitioners, service users and individuals with lived experience of stigma. At each stage of the animation production, I have attended the Newcastle Service User and Carer forum. Inclusion of those with lived experience of stigma was essential in these discussions and has been key in helping to shape the direction and design of the animation, particularly in relation to service needs and solutions.

A key challenge during this work has been ensuring we produce an animation which doesn’t unintentionally stereotype or stigmatise individuals through the imagery used. There has been a lot of thought-provoking conversations and discussions which have led to both personal and professional reflections. For example, figures in early storyboard drafts of the animation which were uniformly male and able bodied were subsequently changed to be more inclusive and represent a diverse range of bodies. Throughout the process there have also been a lot of discussion in relation to the language that we use to support the imagery. Some key insight was gained from the Newcastle Service User and Carer forum where participants identified examples of where they had felt stigmatised through language and how potential changes could have changed outcomes. These examples have been included within the animation to highlight the impact of language.

We plan to share the animation across a range of practitioners working within fields such as drug and alcohol, mental health and wider health and social care roles. This will support the drive to encourage sign up to the Anti-stigma network and prompt organisations to develop an anti-stigma strategy for their workplace. Alongside this we wish to support practice improvement by developing a stigma education package, which the academics are leading on, and which we hope to eventually deliver through an educators by experience model.

Addressing stigma will require individual and collective action from all of us, and so we urge you to please watch and share the animation, use the resources available, sign up to the Anti-Stigma Network and help us to spread an anti-stigma approach.

Background and context

Addressing stigma is a key priority in Newcastle upon Tyne. In 2022 the Director of Public Health report stipulated that policy and practice should ensure health improvement is free from stigma. This issue is also gaining National traction, with the Office for Health Improvement and Disparities (OHID) recently announcing the project ADDER stigma indicator programme and currently adapting Professor Carla Treloar’s (University of New South Wales) Australian stigma indicator and monitoring model for the UK. The NHS Alliance Stigma Kills campaign has recently been rolled out, with the North East and North Cumbria Integrated Care System (ICS) backing this campaign for our region. The Anti Stigma Network has also recently formed to raise the profile and awareness of stigma, especially the impact on people who use or have issues with drugs and/alcohol.