Agenda item

This paper provides the Health and Wellbeing Board (HWBB) with an update on the implementation and delivery of Goal 6 in the Joint Local Health and Wellbeing Strategy 2022-2032. It also includes information on performance monitoring.

This report was presented by Director of Public Health who explained that this report concerned goal 6 of the health and wellbeing strategy; addressing the reduction of health inequalities within specific groups. These groups had been defined as people with a severe mental illness, people who have a learning disability, gender health inequalities and what are known as “inclusion health groups”. This latter category included people who are homeless, people with addictions, people from gypsy Romany or traveller communities. These groups as a whole typically experienced the worst health outcomes in terms of life expectancy throughout the city.

He stated that the goal of the report was to try and reach those who suffer health inequalities to give them rounded and holistic support. It was deliberately vague in its wording because the intention was to flesh this out in time, the scheme was at the co-production stage alongside York CVS, who were putting out an expression of interest for that particular project, with the intention that a lead Voluntary, Community and Social Enterprise (VCSE) delivery partner would be appointed by the end of November 2025. He thanked York CVS for their substantial contribution to this report.

He discussed Action 18, which was implementation of a community-based intervention to reduce health inequalities focused on children and young people. Working together with York CVS and the ICB this was the main project the action was focused on.

He discussed Action 19, which covered chronic disease prevention in the CORE20PLUS5 groups; this was an NHS initiative committing more resources to the “Core 20”, people living in the 20% most deprived areas, people in plus groups, inclusion health groups and in five key clinical areas which are essentially the five big things which kill, such as cardiovascular disease where there had been very good progress, particularly in the way primary care was able to identify people living in inclusion health groups. He noted that this was only the first step, because knowing someone for instance is from a gypsy/traveller background, a care lever, a veteran, or has experienced homelessness was only a first step; no action was actually being taken at this stage.

He discussed Action 20, around the Poverty Truth Commission, where the council had adopted and implemented a really simple set of standards for delivering kind, compassionate, responsive care and service to York residents and other partners had also considered these. The neighbourhood model was being brought forward in York, and standards were being put at the heart of the practice through this model. He noted that there had been really good work under this action in adopting these standards and assured the board that this would continue.

He discussed Action 21, which concerned taking Poverty Truth Commission further and establishing it for children. Again, working with York CVS, it was hoped that that work would progress in the next few months. There would be differences in the service presented for children as opposed to adults, but the board would be updated on progress going forward.

The board asked about data in the report annexes – this data specifically focused on one aspect (mental health and learning disabilities) and the board wondered whether these measures were the only ones available; these areas covered a huge range of people, and members wanted to know whether it was possible to further break down the data. The Director of Public Health answered that the report had utilised all the data which was available, and admitted that the aim of reducing inequalities was a broadly defined goal. He defended the inclusion of this broad goal in the strategy by saying the outcomes were so much worse for these identified groups, and work did need to be done. The problem was that there is no nationally validated data on groups like homeless people, gypsy travellers etc. In future reports, Public Health in York could go further with this, even if only qualitative data was available. When it came employment statistics for the stated groups, Public Health were pulling from national data sets on disability and employment data. Internally within the social care teams York probably had much more data on support needs, but not on population-level sets. This should not necessarily be taken as an indicator of how York was doing on a national level; some of the data was inadequate but the Public Health team had to work with what was available.

Board members acknowledged that this would allow the team to measure York against other places, and that this task should not fall exclusively to the Public Health team. Again, the valuable role played by Healthwatch in obtaining local data was raised. It was suggested that in future, other partners could bring data in and Public Health could use their expertise to look at this.

Board members asked about the Excess Under 75 mortality rates for adults with Severe Mental Illness, cited in the report. The Director of Public Health explained that if a regular person has mortality of 10/100 person with mental illness may have 47/100. This represents a huge inequality, which was very high nationally and even more so in York. He suggested inequalities like this may be due to a combination of structural factors, cultural factors within medicine and factors within lifestyle. The board suggested that this represented a good opportunity for Voluntary, Community and Social Enterprise partners to take a role as many people would be more willing to discuss things with them that they would not with medical professionals. The Director of Operations and Transformation, TEWV stated that a key strategy for the trust was to address these health inequalities and ensure people's access to appropriate primary care was supported. He stated that there were now far more physical health practitioners working alongside people with severe mental illness, both during their inpatient stay and also to ensure they were addressing and accessing appropriate support on discharge.

Resolved:   To note and comment on the updates provided within the report and its associated annexes.

Reason:      To ensure that the Health and Wellbeing Board fulfils its statutory duty to deliver on their Joint Local Health and Wellbeing Strategy 2022-2032.