Agenda item

Harpal Aujla (Specialty Registrar in Public Health) presented the item and raised the following points: 

·        NHS England required all local authorities to produce a strategy by March 2022 to show how we're going to tackle inequalities locally but WCC’s strategy was done with Coventry  

·        The aim of the strategy was to obtain health equity across Coventry and Warwickshire (resolve unfair differences between ethnicity groups), reduce health inequalities (every relevant piece of council work to resolve health inequalities) and challenge the system as a whole 

·        Health inequalities in Warwickshire included life expectancy which was slightly higher than the national average (79.9 compared to 79.6 for men and 83.6 compared to 83.1 for women). However, there was a big gap in life expectancy between deprivation areas and non-deprived areas. Deaths in deprived areas class as avoidable  

·        The King’s Fund Health Equality model showed that not just health behaviours could be addressed to tackle health inequalities and wider determinants like lifestyles, places, communities and an integrated care system need to be looked at. To do this, major programmes were done with Coventry  

·        Work with NHS England was done to create Core 20 +5 which became embedded across the system. Core 20 are the most deprived 20 groups in in the country and this would be one element of tackling health inequalities. The +5 are the five clinical areas (maternity, early cancer diagnosis, severe mental illness, chronic respiratory disease and hypertension)  

·        The plus group could be locally determined so work was done with the local place partnerships to ask them what their plus groups were. These included travellers, people with learning disabilities and people in rural isolation.  

·        For ethnic minority communities, a quick analysis was done to look at the 20 nationally most deprived areas and fewer ethnic minorities were in deprived areas in Warwickshire compared to the rest of the country 

·        Children at risk was being worked on but it could be more locally determined whereas the Core 20 +5 groups had been predetermined, however this was still being worked on because of evidence gathering for each section  

·        Early cancer diagnosis in Coventry & Warwickshire had 52.7% of cancers diagnosed at stage one or two but the goal was 75% by 2028. Ethnicity was not recorded with this 

·        The NHS set out five key priorities, but Coventry and Warwickshire wanted six high impact actions to get a long term focus and capture things like inclusion and workforce development 

·        The model to achieve everything was called ‘levelling up health’ which will narrow down the authorities’ goals with different tools. This will target disadvantaged communities with a health equity audit assessment tool to be embedded in all health strategies  

Following several questions from Councillor Jonathon Chilvers, Harpal Aujla stated that life expectancy recently ‘tailed off’ but it was not clear whether the deprivation gap was growing or not. The gap with health inequalities did grow though. Dr Shade Agboola confirmed that the pandemic made the health inequalities between the most and least deprived in the population worse.  

In response to Councillor Sinclair, Harpal Aujla confirmed that life expectancy only measured mortality and not how healthy a life is; more deprived areas had less healthier lives. Dr Shade Agboola added that prior to austerity measures being introduced, as an absolute, life expectancy increased with all groups but there was adecrease in healthy life expectancy for people in more deprived areas so a sustained increase in life expectancy overall, has not been observed due to a halting of life expectancy in the most deprived groups.  

Following supplementarys from Councillor Sinclair, Dr Shade Agboola stated that they were asked to develop and lead a systems health inequalities plan across Coventry and Warwickshire as an ICS (integrated care system). The strategy will set out how the system plans to tackle this over the next couple of years in a very high level strategic paper. Work was done with community groups and small projects, as well as the districts and boroughs, to see whether they could tackle some of the underlying factors responsible for the worse outcomes seen in minority ethnic groups. This strategy was still being developed at the time of the meeting and it was important that Warwickshire’s health inequalities were not too overshadowed by Coventry’s as Coventry had more health inequalities than Warwickshire.  The Core 20 +5 system was being used to capture these groups as part of the strategy with an action and implementation plan which would be drafted by March 2022.  

In response to Councillor Kate Rolfe, Harpal Aujla clarified that there was an overlap of deprivation between Coventry and North Warwickshire and there was a deprivation issue in Rugby too. It was important that ethnic minority groups were not missed in Warwickshire but they were the second least deprived group in Warwickshire.  

Following several queries from Councillor Bell, Harpal Aujla stated that they were planning to reduce the gradient in health inequality between the most and least deprived areas. Tailoring interventions so that they are proportionate to the degree of need is called proportionate universalism in public health.Dr Shade Agboola stated that there was always room for improvement that will not disadvantage less deprived groups. Resources and interventions should be targeted in areas where people were less likely to engage as this worked well. Everyone should be given access to services with some targeted support for people who were least likely to engage with universal services.  

In response to Councillor Richard Baxter-Payne, Dr Shade Agboola confirmed that they used regionalised data from the boroughs and districts regarding life expectancy and other elements. There were multi-dimensional plans in place with the ICS to make residents take note of the strategy and show them how they would be supported.  

The Chair informed the committee that Nuneaton and Bedworth Borough Council obtained a clinical trial for early cancer diagnosis; residents aged between 50-77 would be invited to a mobile station for a blood test. 

Resolved:

1.          Note the requirements for a Coventry and Warwickshire Health Inequalities Strategic Plan.

2.          Support the recommended local priority population groups for the strategic plan (covering transient communities; black and minority ethnic groups; people with disabilities; older people experiencing rural deprivation).

3.          Support the implementation of the plan and ensure organisations are implementing the plan as single organisations and in partnership with others.