Sarah Prema, Executive Director of Strategy and Planning for Leicester, Leicestershire and Rutland CCGs will present a report on the Leicester Leicestershire and Rutland System Health Inequalities Framework. The aim of the Framework is to improve healthy life expectancy across LLR, by reducing health inequalities across the system.
Sarah Prema, Executive Director of Strategy and Planning for Leicester, Leicestershire and Rutland CCGs presented a report on the Leicester Leicestershire and Rutland System Health Inequalities Framework. The aim of the Framework was to improve healthy life expectancy across Leicester, Leicestershire & Rutland (LLR), by reducing health inequalities across the system.
The purpose of the Framework was to:-
· Provide a system mandate for action to address health inequalities from communities upwards through the whole life course from birth to death across LLR.
· Establish a collective understanding of the terms ‘Inequality’, ‘Inequity’ and ‘Prevention’ in relation to population health, across all parts of the LLR Integrated Care System (ICS).
· Strengthen a whole system collaborative approach to reduce or remove avoidable unfairness in people’s health and wellbeing in LLR as the issues affecting health were complex and joint working was important as all the factors interacted.
· Establish the high-level principles of how LLR ICS partners will approach the work of reducing health inequity at system level.
· Recognise that the framework will be implemented and agreed at system level, with much operational, political and community action being undertaken at ‘place’ and ‘neighbourhood’ level. It is the systems’ minimum ask of Place in relation to reducing health inequalities.
· Set out some key actions that can be delivered at system level with support through the ICS, with recognition that some actions will be primarily for individual organisations e.g. the NHS or the Local Authority with many others requiring partners to work together.
· As the ICS developed there would be a need to adopt proportionate realism to use resources better to bring service provision delivery together around health inequalities.
· The training and development of staff was important, and organisations would need to learn from Covid-19 experiences for service delivery.
· There would be a consistent approach to health equity audits when commissioning and delivering services to ensure there was fair access to all; e.g. digital services did not disadvantage unintentionally.
It was noted that the principles of the approach would be:-
· Health inequalities are 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 principles and actions outlined are deliberately high level – the framework is clear in identifying that it will be at place level and footprints below that specific action will be defined. Health and wellbeing Boards have a key role in leading and overseeing the work to establish local needs and action plans.
· Health outcomes are the result of a mixture of the wider determinants of health and the quality of the health service. It is estimated that non-medical factors influence as much as 80% of life expectancy.
· To optimise the health, wellbeing and safety of our population then all partners involved have to work together to impact all the factors that influence health inequalities.
· Reducing health inequalities will create a fairer society in which people are enabled to realise the best potential and contribute to our society in positive ways.
· The ICS will adopt a Population Health Management3 and balanced approach to Prevention (across all three tiers).
· A focus on parity of esteem between mental and physical health.
· Public sector ICS partners will act as ‘anchor institutions in LLR.
· Both qualitative and qualitative data would be used to better understand the health inequalities that exist in LLR.
· All the assets and strengths of communities and individuals would be used to reduce health inequality and inequity.
· Effective action would be taken at key points of the life course dependant on need.
· Accountability for delivering on system wide health inequalities will be an ICS system accountability.
· Actions will be undertaken at the most appropriate level of the ICS where they can be most effectively owned and delivered.
· There would be a proportionate universalism approach to invest decisions across the ICS. This would allow actions to be universal, but with a scale and intensity that is proportionate to the level of disadvantage.
· The ICS will establish a defined LLR resource to review health inequalities at the system level. This will be a virtual partnership between the NHS, the local authorities and local universities
Members of the Board supported the principle of the framework and commented that:-
· There has been a cyclical revisiting of health inequalities over the years and although there had been a data rich environment there had been no follow up on quality of engagement and analysis.
· Training and sharing of resources to make a difference was supported.
· The challenge to address inequalities is to ensure a collaborative approach to improve healthy living conditions and education of issues. There still a need to build on the involvement of planning, transport and housing etc.
· The ICS supported the involvement of a wide range of organisations in developing the framework and the ICS would be really keen to see the framework put into action as a high priority to produce positive results.
· As the issue had been considered before communities needed to see real change and improvements. There are many people in the community that are wanting to do things to make improvements and they needed ot be involved in the action to bring about improvements. There are many marginalised groups in the community, and they are not represented in the developing the proposals.
· The Board involvement in holding partners to account for actions was welcomed as discussing the actions and non-actions arising from the framework would lead to prioritising resources.
· Most of the inequality challenges were in the west of the city compared to the inequalities across the city as a whole.
· Proportional universalism was welcomed to directing resources to areas where there is an identified instead of everyone getting help regardless of their needs.
· Hospitals had traditionally treated those who turned up at hospitals and inbuilt inequalities had evolved within the system over time. There were inequalities in those not attending their first appointments. The average non-attendance rate was 7% but this could be as much as 50% from some ethnic groups. If patients did not attend the hospital appointment, then they were discharged back to their GP. If there were differential levels of discharge it could help to identify of there were underlying issues relating to non-attendance etc. There were also disparities in providing knee and hip operations depending on levels of wealth and ethnic origins. Those experiencing low levels of wealth might choose to work instead of having the operation until they were unable to work from the pain experienced. It would be important to bring consideration of ethnicity and inequalities into the health system.
· Experiences during Covid had provided information on which communities and section of communities had been affected the most, those groups affected more by hospital admissions and which communities were reluctant to take up vaccines. Factors identified in these differences included access to open space spaces, communal living so not able to exercise social distancing, poverty, exercise and lack of active lifestyle and eating habits. Other comparable cities had been affected similarly with some more than others. It was important to use this information to look back and see how these factors can be address to bring about positive change and health improvements.
· It would be helpful to have simplified and easy to read versions of research projects to inform the work that would be needed going forward and also to inform on improvement engagement which those experiences health inequalities.
· Research studies had linked deprivation to hospital outcomes eg planned and elective operations. The Michael Marmot 2020 Review examined a decade of data to understand the worsening situation of health inequality in the UK. Th report found funding cuts to be regressive and inequitable, suggesting that these financial decisions had harmed health and contributed to widening health inequalities.
· There was a need to level up services and ensure that when services are delivered, they do not create inequalities.
· Adult Social Care and Education Services had looked at data and carried out an internal to see if service delivery was equitable according to their context The department had introduced a participation model, based upon the Lundy model, which ensured staff listened and responded to the views of children and young people they work with. The adoption of this approach was getting Leicester national recognition.
· Work on Anti-smoking and Anti-Poverty had linked factors across a number of services and had shown that a change in one area helped to bring about change in other service areas and had identified the interaction of various factors affecting the outcomes. Getting the right advice at the right time can lead to people being less reluctant to open mail and missing appointments as they feel more engaged and helped.
· The existing Joint Health and Wellbeing Strategy Action Plan could be revised to incorporate and build on the work for the Framework. Officers intended to develop this and then engage partners in this work.
· The CCG had signed up to the Framework and NHS staff and GPs were also committed to it. It was useful to have good clear guidance of where to get the best evidence data or where to go to engage in services.
1) Officers were thanked for the work in producing the Framework which was supported and commented to all partners on the Board, together with the endorsement of the principles outlined in the Framework.
2) There should be a development session to discuss how the Framework can be moved forward by all participants in the Board and consider the issues of proportionate universalism and the factors affecting the inequalities of health.