Inclusion health is an umbrella term used to describe people who are socially excluded, who typically experience multiple overlapping risk factors for poor health, such as poverty, violence and complex trauma. This includes people who experience homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system and victims of modern slavery.

People belonging to inclusion groups, tend to have very poor health outcomes, often much worse than the general population and a lower average age of death. This contributes considerably to increasing health inequalities.

Poor access to health and care services and negative experiences can also be commonplace for inclusion health groups due to multiple barriers, often related to the way healthcare services are delivered.

NHS England has developed an Inclusion Health Framework to help systems to plan, develop and improve health services to meet the needs of people in inclusion health groups. The framework is based on five principles for action:

Inclusion health principles

1. Commit to action on inclusion health
2. Understand the characteristics and needs of people in inclusion health groups
3. Develop the workforce for inclusion health
4. Deliver integrated and accessible services for inclusion health
5. Demonstrate impact and improvement through action on inclusion health

The Office for Health Improvement and Disparities (OHID), has written useful guidance which describes the challenges faced by inclusion health groups, and what healthcare professionals can take to include and support people. They have also produced guidance on language interpreting and translation.

The National Institute for Health and Care Excellence has also developed a guideline on providing integrated health and social care services for people experiencing homelessness which aims to improve access to and engagement with health and social care; making sure care is coordinated across different services. Homeless and Inclusion Health Service Standards for commissioners and service providers are produced by The Faculty for Homeless and Inclusion Health to inform commissioning and provision of health services for socially excluded people.

Core20PLUS5 is a national NHS England approach to support the reduction of health inequalities at both a national and system level. PLUS groups are population groups, defined by integrated care systems (ICS), which experience poorer than average health access, experience and/or outcomes across their communities. This includes inclusion health groups.

ICSs’ are asked to consider approach to improve support for inclusion health groups that include:

• joined up action to mitigate universal policies which can disproportionately affect the most excluded and marginalised groups
• building trust with people and communities; communicating in a way that allows people to understand and use information to make decisions about their own health and ultimately respect their choice.
• improved compassionate care which is personalised, trauma informed strengths-based care that treats people with humanity and compassion
• working with people with lived experience and local partners, particularly the voluntary community and social enterprise (VCSE) sector to evaluate and improve how people in inclusion health groups are supported – taking services to people where it is necessary
• promoting the message that everyone is welcome in general practice and, if necessary, challenging system and professional barriers within health services to ensure people access the services they need. Key resources include the General Practice registration campaign, Safe Surgeries Toolkit and the PCN planning tool.