Agenda item

Steve McCue – Senior Strategic Development Manager, LLR ICB and Mark Pierce, Head of Population Health, LLR ICB to present a report informing the Board of the NHS requirement by NHS England and NHS Improvement to deliver against the CORE20Plus5 to support wider work to reduce health inequalities across Leicester, Leicestershire and Rutland (LLR).

Steve McCue – Senior Strategic Development Manager, LLR ICB and Mark Pierce, Head of Population Health, LLR ICB submitted a report informing the Board of the NHS requirement by NHS England and NHS Improvement to deliver against the CORE20Plus5 to support wider work to reduce health inequalities across Leicester, Leicestershire and Rutland (LLR).

It was noted that:-

·         NHS England defined health inequalities as the preventable, unfair, and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental, and economic conditions within societies.

·         The LLR ICS was aligned to the national vision of ‘exceptional quality healthcare for all through equitable access, excellent experience, and optimal outcomes. Health inequalities exist on a gradient throughout populations, and they were committed to using a proportionate universalism approach to reduce inequity wherever it existed across LLR.

·         Core20Plus5 was a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system (LLR) level. The approach defined a target population cohort – the ‘Core20PLUS’ – and identified ‘5’ focus clinical areas requiring accelerated improvement.

·         The Core 20 referred to the most deprived 20% of the national population as identified by the national Index of Multiple Deprivation  (IMD). The IMD has seven domains with indicators accounting for a wide range of social determinants of health.  In Leicester, Leicestershire & Rutland (LLR), 153,284 registered patients live in the 20% most deprived neighbourhoods in England. In Leicester this was 31.7% of the total number of registered patients compared to 3.2% for Leicestershire and 0.4% for Rutland.

• The Core20Plus5 framework set out five clinical areas of specific NHS focus. Governance for these five focus areas sat with national NHS programmes and national and regional teams coordinate local systems to achieve national aims. The five clinical areas included;

o   Severe mental illness (SMI): ensuring annual health checks for 60% of those living with SMI (bringing SMI in line with the success seen in learning disabilities)

o   Early cancer diagnosis: 75% of cases diagnosed at stage 1 or 2 by 2028.

o   Hypertension case-finding: to allow for interventions to optimise blood pressure and minimise the risk of myocardial infarction and stroke

·         Using this framework would not tackle all health issues but it was still a good tool to improve Health and Wellbeing.  There were also elements that are locally determined, and officers will be working on those and bring a report to a future meeting to see which specific needs to be involved or where services were not serving groups very well e.g. communities that experienced vaccination issues during covid etc.

During discussion Members of the Board commented that:-

·         The approach was a good opportunity to have a forensic look about talking about deprivation in providing health care.  There needed to be clarity on governance and what would be done if there were differences on place level and system based levels.

·         It was positive that there were local decisions to be made and everyone needed to understand what these were and then take through the ICB to make the right decision.  When this was considered again it should have more details on public engagement

·         There wa a need to understand health inequalities in Core 20 plus 5  but health inequalities have been known for some time.  There was a need to be focused on what was being done now to address inequalities and have evidence for it and, if this was not possible there was a need to ask why it can’t be provided. 

·         The County Council were making approaches to the ICB to protect the county hospitals so it was important that the City needed to make representations about deprivation, otherwise it will lose out again.

·         Proportionate universalism was supported where the resourcing and delivering of universal services at a scale and intensity proportionate to the degree of need. Services are therefore universally available, not only for the most disadvantaged, and are able to respond to the level of presenting need. It would be difficult to make inroads in improving health and wellbeing if the focus on the need was nor paramount. 

·         Whilst this initiative was supported it did not engage with the remaining 80% to look at and underpin good health outcomes in education and housing. It was somewhat unfortunate that this had come through a health route and not a wider route for consideration. The aim should be to on how the focus was prioritised for all and not get overshadowed by concentrating on the 20% in deprivation

The Chair commented that there was a concern that the Board had its own strategy and priorities and there was a risk that the same thing could be created elsewhere with different name.  Governance issues were important, and place was about the City and our health inequalities.  Engagement of the public was crucial, and each organisation did it differently.  If possible, there should be a tie up and it would be helpful to have a paper on engagement with the public looking at co-production of engagement by partners as a way forward as there was a need for a much more joined up approach and have a system in place to consult for all partners organisations to consult together and provide feedback to the ICB as well.

RESOLVED:-            That the report be received and all partner organisations work together to on an initial focus on Leicester population cohorts who already experience health inequalities and that a further report on progress of the initiative be submitted in the future taking into account the comments made by Board Members.