1. Initiatives for Reducing Health Inequalities in the Bowel Cancer Screening Programme

2. Health Inequalities Learning Disabilities Learning Disabilities Low Literacy Levels Low Literacy Levels Mental Health Problems Mental Health Problems Sensory Impairment Sensory Impairment – Blind and Visually Impaired People – Deaf and Hard of Hearing Community Black and Racial Minority Communities Black and Racial Minority Communities Travelling Communities Travelling Communities Prison Population Prison Population Homeless Homeless

3. Learning Disabilities Increased risk of developing Bowel Cancer Linked to obesity and poor diet Linked to obesity and poor diet Lack of physical activity Lack of physical activity Exclusion from screening programmes Exclusion from screening programmes Higher Mortality Linked to late presentation of symptoms. Linked to late presentation of symptoms.

4. Barriers for patients with Learning Disabilities/Difficulties Communication Communication Recognition of ill health is often difficult. Signs and symptoms for bowel cancer not always recognised Recognition of ill health is often difficult. Signs and symptoms for bowel cancer not always recognised Literacy level Literacy level Resources / lack of pictorial easy read information Resources / lack of pictorial easy read information Practical issues for completion of the Faecal Occult Blood Test Practical issues for completion of the Faecal Occult Blood Test

5. Initiatives Easy Read Patient leaflet Easy Read Patient leaflet Anticipatory Care Calendar Anticipatory Care Calendar DVD DVD Training and working across Cheshire and Merseyside Training and Awareness raising sessions for staff working across Cheshire and Merseyside Community Events Community Events

6. Mental Health Schizophrenia Schizophrenia Recent research shows that people with this condition are at increased risk of developing bowel cancer

7. Barriers for patients with Mental Health problems Lack of awareness about the benefits of screening Lack of awareness about the benefits of screening Poorer knowledge of health topics Poorer knowledge of health topics Low self esteem Low self esteem Lack of motivation Lack of motivation Difficulty in accessing services Difficulty in accessing services Practical issues for completion of the Faecal Occult Blood Test Practical issues for completion of the Faecal Occult Blood Test

8. Initiatives Training and Awareness Raising Sessions for staff across Cheshire and Merseyside Training and Awareness Raising Sessions for staff across Cheshire and Merseyside Distribution of DVD Distribution of DVD

9. Sensory Impairment Blind and Visually Impaired People Difficulty in understanding written invitations and information ( The Facts) Difficulty in understanding written invitations and information ( The Facts) Difficulty with completion of the Kit Difficulty with completion of the Kit Access Access

10. Deaf and Hard of Hearing People Communication Communication British Sign Language is their first language,structure is different Difficulty communicating needs with Primary Health Care Teams or secondary Care Difficulty communicating needs with Primary Health Care Teams or secondary Care Less aware of benefits of screening Less aware of benefits of screening

11. Initiatives Research Chester University Research Chester University CD CD Locally produced CD DVD DVD Interpreted into British Sign Language and subtitles for Hard of Hearing British Sign Language interpreter

12. Black and Racial Minority Communities Culture Culture Language Language Invitations and Information sent out in English Invitations and Information sent out in English Access Access Less aware of benefits of screening Less aware of benefits of screening

13. Initiatives Involvement of Social Inclusion Team Involvement of Social Inclusion Team Education Sessions Education Sessions Locally produced DVD-13 Languages Locally produced DVD-13 Languages Translated pull-ups and Posters Translated pull-ups and Posters Community Events Community Events Interpreters Interpreters

14. Travelling Communities Culture Culture Low Literacy Low Literacy Self Contained Self ContainedInitiatives Designated Health Visitor for Travelling Community Designated Health Visitor for Travelling Community Easy Read Pictorial Leaflet Easy Read Pictorial Leaflet DVD DVD

15. Contact Details Maureen Sayer Maureen Sayer Health Improvement Practitioner Health Improvement Practitioner maureen.sayer@aintree.nhs.uk maureen.sayer@aintree.nhs.ukmaureen.sayer@aintree.nhs.uk