Report of York Health and Care Collaborative; Update November 2022

1. Introduction

This report provides update on the work of the York Health and Care Collaborative (YHCC).

2. Progress on Priorities;

2.1 Deprivation/Cost of Living Crisis - Background

Earlier this year analysis was completed to look at the biggest drivers for attendance at A&E; it has long been assumed that a person's proximity to hospital would have the biggest influence on their attendance. However, the data collected showed that those living in the most deprived areas of York are more likely to attend A&E than those that live nearby. This prompted discussions on the ways that deprivation affects attendance at different health and care services in York. YHCC chose to focus solely on this topic in a system-wide workshop.

Deprivation Workshop – In May, YHCC ran a workshop that looked at the impact of deprivation on access to health and care services. Attendees were asked to consider 'How people from a deprived background access a particular service, or receive care in a way that is different from the wider population?' The minutes of this workshop were shared with the Health and Wellbeing Board (HWBB) in July 2022 and appended here for information (Appendix 1).

As a result of this workshop YHCC asked the HWBB where it thought the gaps were in supporting deprived communities in York, to aid the group in future discussions about how YHCC can assist closing these gaps by working together.

In July 2022, City of York Council (CYC) declared a Cost of Living Emergency, YHCC has continued to discuss the ways that the increased cost of living is affecting the population of York, and the resources available to help those most in need. Cost of living summits have also been set up by York CVS and CYC.

The rapidly increasing cost of living means that those who were previously experiencing poverty are now being impacted even more and many individuals that have never previously struggled to meet their costs, now do. This is evidenced through a questionnaire that was shared amongst organisations across York (through YHCC) which uncovered the extent to which people working in health and care now fall into this group. There were 97 responses received from staff working in Primary Care, Community Health Care, Mental Health Services, Hospital Care, Social Care, Community Pharmacy, Public Health and Drug and Alcohol Services (Appendix 2 is a summary of results from the questionnaire). Responses to the questionnaire show that some of the lowest paid health care staff are having to seek alternative employment to make ends meet with some having to cut down on purchasing essential items, such as food. This comes in a year when Aldi offered its lowest paid staff three pay-rises of up to 9%, taking all staff to at least £11 an hour. As a result, health organisations are finding it increasingly difficult to compete with private sector jobs and a number of staff are leaving for better paid, often less stressful jobs. This is placing the health and care system under immense pressure.

Through discussions with YHCC attendees, we understand that the primary care contract uplift is equal to approximately one-third of the increase in the costs arising from annual staff pay increases and rocketing utility bills. This leaves little possibility of offering further pay enhancements to retain staff.

In addition to financial difficulties, the increased cost of living is causing increasing levels of non-health anxiety which for many, drives increased health anxiety. It was reported through YHCC that there has been an increase in people accessing voluntary services to discuss money and their concerns about making it through the winter.

The increase in health-related anxiety is having a direct impact on the demand for health and care services as we head into winter. It will also have an influence on the services that people choose to access, for example more people may choose to attend ED to be seen more quickly, which could create longer waits than those already experienced.

YHCC would like to ask the Health and Wellbeing Board how it can assist health and care partners in York to put additional support into services to help those experiencing high levels of health and non-health related anxiety, some for the first time.

For further context a paper written by East Riding Public Health and shared with East Riding HWBB was considered by YHCC. Titled 'Cost of Living: The Impact on the Vulnerable in East Riding', the paper illustrates the outcomes of the updated Debt Needs assessment and is attached here as Appendix 3 of this report.

2.2 Actions taken since the Cost of Living workshop

· Discussions are taking place with Primary Care around the option of funding £5 Blue Light Cards for General Practice staff so that they can access discounts on food and other essential goods.

· A toolkit containing text messages is currently being drafted to be shared with primary care practices in York and then sent to appropriate patients to signpost them to resources that are available to help them manage their health and finances this winter. This work will also be shared with York Hospital, and CVS.

· The York place comms team are working on campaigns to share the resources that are available for residents in York.

· Work is being done to look at High Intensity Users (HIUs) of health services. Evidence shows that some residents attend A&E with unusual regularity. Termed High Intensity Users, 25 individuals have attended York A&E more than 750 times this year. 67% of these attendances led to an admission; 33% could have accessed more appropriate care in an alternative setting. Through sharing the resources that are available to help people manage this winter, it is hoped that more people can be stay well at home, or self direct to a more appropriate service other than A&E.

· York A&E is seeing more admissions from under 5s than it did pre-Covid. York primary care, Nimbus and the York Paediatric team have collaborated to restart the Children's Ambulatory Treatment (CAT) hub to allow children to be monitored and reduce the likelihood of them requiring an admission to hospital. Currently operating 2-days/week, York GPs are investing some of the winter pressures money available to practices, to increase this to a 5-day/week service in November.

· Creation of an asset leaflet that will be available to those attending health and care settings with details around services available in York to get help with their increased anxiety/worsening mental health.

· The York Place Primary Care and Finance teams are running a charity challenge through November 2022 to raise donations for York Foodbank.

Minutes of the YHCC Cost of Living workshop:

York is generally considered to be an affluent city with good health education. However, findings from the questionnaire and discussions in YHCC have highlighted that there is a very real problem facing the most deprived individuals, including staff working for health and care services. Following a presentation by York Foodbank, we understand the demand for vouchers is up 60% each month compared to figures from last year and there is a real sense that increasing numbers of people will not be able to afford essentials this winter.

3. Ageing Well, Frailty and Multimorbidity

The YHCC Frailty Steering Group continues to meet regularly, the aim of the group is to understand how to code frailty and ensure that the coding is readily accessible to all health care professionals supporting frail people. The group has:

· Secured funding for all General Practice staff to complete training on Rockwood Frailty Scoring. All practices received a letter in May detailing how the funding can be claimed and some options for delivering the training. The next piece of work is looking at how Rockwood scoring can also be rolled out in non-healthcare settings so that demand does not overwhelm a small number of services.

· Run a frailty workshop in September 2022 to look at the services available for individuals assigned a Rockwood score 1 – 4. As a result, a leaflet is being produced which will be shared with health care staff and give details on what services can offer and the referral details. A process for identifying and recording gaps in frailty has also been agreed, as a result of the workshop. There are 2 further workshops planned to look at assets in the City to support people in the moderate and severe frailty groups. These workshops will be completed by March 2023.

4. Future work and further development of York Health and Care Collaborative in 2022/2023

4.1 Priority Setting

Health and Wellbeing Board identified the 10 areas outlined below to be their priorities:

· Reducing the gap in healthy life expectancy

· Mental wellbeing

· Smoking

· Alcohol

· Healthy weight

· Inequality groups

· Suicide/self-harm

· Diagnosis gap

· Physical activity

· Social connection

YHCC will have a meeting with a focus on each of the priorities starting from January 2023. The cost of living will continue to be a theme that is considered through all discussions.