The Health and Wellbeing Board is asked to consider the requirements for a Coventry and Warwickshire Health Inequalities Strategic Plan, local priority population groups for the Strategic Plan, the progress made to date and support the implementation of the Plan.

The Health and Wellbeing Board was asked to consider the requirements for a Coventry and Warwickshire Health Inequalities Strategic Plan, local priority population groups for the Strategic Plan, the progress made to date and support the implementation of the Plan.

The draft plan was required to be submitted to NHS England and NHS Improvement by 22 March 2022. It must depict a locally agreed strategic approach for addressing health inequalities within five nationally determined clinical priorities, covering maternity care, early cancer diagnosis, severe mental illness, chronic respiratory disease and hypertension. It also had to show this work was embedded within a broader approach to reducing health inequalities within Coventry and Warwickshire. A programme of engagement with partners and key NHS workstreams was underway to shape the Strategic Plan and ensure the approach took into account the needs and inequalities within each of the three Warwickshire ‘Places’ (Warwickshire North, Rugby and South Warwickshire).

The five national clinical priorities were set out within a ‘Core20+5’ model. The model required focused efforts to improve health access and outcomes for those living in the most deprived 20% of the population. There was evidence to show the inequalities in health outcomes, life expectancy and in terms of maternal deaths and morbidity amongst some ethnicities. The five clinical priorities were primarily focused on secondary and tertiary prevention approaches. Overall, life expectancy in Warwickshire was above the national average. However, there was variation by deprivation and gender with data provided in the report and appendix to demonstrate this.

A key area was determining the local priority population groups and the following were recommended:

·       People from black and minority ethnic groups

·       Transient communities (homelessness, gypsies, travellers, boaters and newly arrived communities)

·       People living with disabilities (physical, sensory and/or neurological)

·       Older people experiencing rural isolation

Within Warwickshire 6.5% of the population, approximately 38,000 people, lived in the most deprived 20% of areas nationally (based on the indices of multiple deprivation). There was a need locally, to broaden the scope beyond the most deprived national quintile in order to adequately address the disproportionate impacts the pandemic had caused on ethnically diverse communities within Warwickshire. Data was provided to demonstrate this. Subsequent sections of the report expanded on the rationale for selecting each of the proposed local priority population groups.

The Board discussed the following areas:

• The Chair asked the Board to focus on the proposed ‘Plus’ areas which could be varied as several aspects within the report had to be included.
• Sarah Raistrick asked if the proposed areas were data driven and there would be tangible outcomes and improvements from the targeted resources. From an NHS perspective there would be measurement of the results, but for residents it was important that the resultant improvements could be demonstrated too. She reminded of her earlier points about children and in this report, after maternity there was quite a gap before any of the health conditions referenced affected children. She suggested selecting a priority that was universal to Warwickshire’s population. This could then include targeting resources proportionately to areas where there was inequality. The Board was asked to approve the proposed areas, but there was a need for clarity to understand exactly what the proposals were. She also referred to the Kings Fund model, the anchor institutions, and the involvement of partners in this joined up piece of work. The outcomes from this work were health measure outcomes, but the Kings Fund model showed a lot of the determinants as social determinants. There was a need to work together, as it was too late when there were poor health outcomes.
• The Chair added that the Board was being asked to approve the ‘plus’ aspects but needed sight of the evidence to understand why these were the preferred options and she asked what the process was for finalising the plus outcomes.
• Councillor Barker had been involved at a place partnership meeting but did not recognise all of the aspects included.
• Councillor Roodhouse had slight unease about the elements reported. He used the example of rural isolation for older people which he recognised, but it could similarly be an issue for younger people in villages and people in urban areas too. He referred to homelessness, the potential impact of savings plans exacerbating numbers of homeless people, the underreporting of homelessness and linked this to issues for younger people and mental health conditions.  Delivery was important and assessing its impact.
• Councillor Matecki had also been involved in the South Warwickshire Place discussions. There was confusion as the priorities agreed for that area may differ from other places and the strategic level, which could result in a lot more priorities than feasibly could be delivered.
• Harpal Aujla was asked to explain the process undertaken. There was significant overlap between core 20 and the other aspects. The plus groups were headlines which would be supported by workstreams with a lot more detail. The aim at this stage was to identify the key groups that were experiencing inequalities. There would be delivery plans and monitoring arrangements.
• Stella Manzie commented that in Warwickshire the breakdown of BAME communities was quite complicated. In some parts of the county there may be small groups and different communities who may be more isolated when compared to a large ethnic group in Coventry. There was a need for a granular analysis. Some of the priorities were really clear and she demonstrated this using the example of maternity outcomes for Asian and black people. The ‘plus’ aspect was more complicated and would need that more granular analysis to show what the Board was agreeing to.
• The Chair suggested that a further report be provided to the Board with an evidence base for the ‘plus’ aspects and the delivery plans which would underpin them. It was useful seeing what the place partnerships had considered but the evidence base was needed for the Board.
• Sarah Raistrick stated the potential for unevidenced priorities to be included in the ‘plus’ aspect. She was interested in seeing which aspects included in the ‘plus’, that were not also referenced in other areas and used the example of cancer screening services for gypsy and traveller communities which was duplicated. There was a danger in trying to include too many aspects and not being able to demonstrate an improvement had been achieved.
• Emily van de Venter contributed that one of the challenges in developing a system-wide strategy was the number of people inputting with differing views. This work built on the Joint Strategic Needs’ Assessments and discussions at place which had developed the priority plus groups for Warwickshire as a whole and then were adapted locally. The draft submission to NHS England was due in late March 2022, but there would be additional time needed for further system engagement. Due to the time constraints, additional information would be circulated ahead of the next Board meeting.
• There was a joint place forum in March which could provide a mechanism for further consideration of this item, to be followed by a virtual sign-off.

Resolved

That the Board:

1.     Notes and comments on the requirements for a Coventry and Warwickshire Health Inequalities Strategic Plan as set out above.

2.     Notes and comments upon the progress to date, as set out above.

3.     Supports the further development of the ‘plus’ aspect, the action plan and the communication strategy and that a further report comes back to the Board.