Agenda item

The Consultant in Public Health introduced an update on the 2023 Health Inequalities Programme. In 2022, the Council had received six months’ worth of funding from the North East London Integrated Care Board (NEL ICB) to work on addressing health inequalities. The Council was committed to using this funding as an opportunity to build the partnership approach in Barking and Dagenham, to ensure that this was place-based, co-produced and co-delivered across the place partners, and to influence the wider system in terms of its working styles and culture. This update also provided context as to:

·  Inequalities challenges in Barking and Dagenham, across the life course;

·  The types and principles of interventions that were proven to reduce health inequalities and increase health equity; and

·  The eleven Barking and Dagenham health inequalities programme workstreams.

The Health Lead (HL) for Community Resources then updated the Committee as to partnership working that had been undertaken as part of the programme, as well as the importance of community power and community agency in the prevention of ill-health. The update also provided context as to the work that had been taking place as part of the localities approach, such as mapping with residents in terms of assets that they identified as connecting places in the community, and future work that was to be undertaken, such as a podcast starting in June 2023, which would ask residents who they turned to when they faced difficulties in their lives. Much work was being undertaken in this space, with the HL highlighting the importance of joint-working and innovation.

The Chief Operating Officer (COO) at the Together First Community Interest Company (TFCIC) reiterated the importance of partnership working, as well as highlighted issues within the health system, such as people in Barking and Dagenham getting older age frailties up to two decades before people in non-deprived boroughs, yet funding to GP surgeries in the Borough was not reflecting this and resulting in the Community Sector often needing to pick up the gaps. He highlighted numerous positive examples of partnership working in addressing health equalities and detailed some of the workstreams relating to these.

The Chair of the TFCIC then highlighted the extent to which the Covid-19 pandemic had made visible the challenges faced by residents, as well as the need to work differently. She detailed some of the work undertaken by the Borough’s Health Inequalities Leads, such as community pop-up clinics and winter coat appeals, and work being developed, such as breast screening programmes for those patients with serious mental illness or learning disabilities, as well as work to support young carers with their caring roles. She emphasised the need to work innovatively to address issues, with the Place-based Partnership essential in collaboratively building on infrastructure. The Programme Director of the TFCIC also highlighted the benefits of close partnership working with the GP leads and their enthusiasm, and the innovative nature of the work being undertaken.

In response to questions from Members, officers stated that:

·  Through the TFCIC and Public Health working collaboratively, officers had been able to compare the ethnic makeup of each borough ward against the different cohorts that were coming forward for Covid-19 vaccinations during the pandemic. They were then able to look to improve the figures for uptake through targeted communications, and encouraging community leaders to send out vaccination uptake messaging to their communities. This method had proved to be very successful in improving vaccination rates. They had also created risk lists of those residents with the highest risk of decline should they contract Covid-19, and worked to encourage their vaccination uptake, such as through having nurses call them in their native languages, to arrange their vaccination appointments.

·  A further success story had been through encouraging patients with learning disabilities to attend Covid-19 vaccination appointments at the Vicarage Fields site, which was familiar to them and enabled them to have confidence in attending.

·  From a community perspective, it had been noted that there was a big issue in terms of trust and building trust; there had been nearly 2,000 conversations with local residents, from a wide range of ages and ethnicities, and this theme of trust had featured frequently. The sector had helped to link an Eastern European lady, whose son had autism, with other parents of children with autism, to mutually support and connect with each other, with the group starting out at 8 parents and now spanning 40. Whilst services did often need to be involved in providing support, it was important to note that connecting individuals with local neighbourhood support networks could be just as vital.

The Cabinet Member (CM) for Adult Social Care and Health Integration noted that whilst it was recognised at a North East London level that work needed to be undertaken around health inequalities, the formula used by NEL ICB, as was the case nationally for allocating funding, was based on the previous census and not the current one. Whilst the first year of the funding allocations had been based on a bidding process, the funding this year had returned to the national formula, which meant that Barking and Dagenham had lost out on £400,000 worth of funding. Provisions had been made in the Council’s Public Health Grant for this year to account for this £400,000 funding, so that funding could continue for identified projects for another year. As the commitment from NEL ICB was for three years, the Council knew that it would receive another £700,000 over the next two years, which enabled it to plan, and by making up the £400,000 shortfall, this would give all the capacity to jointly lobby for an additional allocation going forward.

The COO at TFCIC explained that Barking and Dagenham was let down in terms of funding, with GP practices in the Borough being paid for around 20,000 fewer patients than it actually had due to the weighting formula. The reason for this issue was due to the younger average age of the Borough. Furthermore, other national and London funding weightings also meant that Barking and Dagenham was frequently let down in its allocations, which exacerbated health inequalities in the Borough, particularly as residents tended to suffer from health conditions at an earlier age that those in other parts of the country.

The Chair of TFCIC stated that these challenges were faced by GPs on a daily basis and were also evident through workforce retention. Whilst positive news had been received that 5,000 more GPs were to be trained, with 100 of these likely to come to London, there was an issue whereby GPs had been trained in the Borough, but then moved elsewhere due to the lack of an inner London weighting pay. The CM stated that these issues were well acknowledged by NEL ICB and it had given a commitment to look to address these. There was also now a commitment from the three inner London Boroughs (Tower Hamlets, Newham, and City and Hackney) to receive a standstill to their funding allocations, whilst the outer London Boroughs caught up; positively, there was an acknowledgement that funding needed to be evened out. The Health Lead for Community Resources stated that a systems approach needed to be taken, working together differently to address inequality and the Programme Director for TFCIC stated that staff retention issues were also due to the tough working conditions across London.

In response to further questions from Members, officers stated that:

·  One of the projects that Public Health had commissioned the TFCIC to undertake had been around health checks for those aged 30-39 in the BAME community, as Public Health had recognised a need for this through data. This project had been particularly successful in encouraging those who may not normally approach Health services, to receive health checks.

·  TFCIC was also looking into how services could be provisioned differently, within the community hubs through pop-up clinics. It was also working on childhood immunisation uptake, and targeting its public communications messages differently to increase this, as well as encouraging uptake through using health checks to begin these conversations. It was also looking into targeted clinics, such as for veterans, and into increasing GP registration.

·  A pop-up clinic at the Borough’s Coronation Festival had been successful in enabling 102 people to receive a health check, who otherwise would not have gone to their GP to have this; however, health check information would be passed to each individual’s local GP, to enable conversations to continue.

·  Colleagues were working to ensure messaging around GP registration was becoming widespread, to ensure that all communities knew that they were able to use GP services for free at the point of access.

·  To ensure long-term change, colleagues were focusing on changing infrastructure and how all partners worked together in practice.

·  The CM stated that colleagues were about to join the place system with the Council’s Health and Wellbeing Board, to become a “Committee-in-common”. This would further increase partnership working, and would also include representatives from the Metropolitan Police, further increasing the depth of debate and expertise.

The Chair requested that colleagues return in six-months’ time, to update the Committee as to the progress of the Health Inequalities Programme.