Agenda item

The Health and Wellbeing Board will consider a report which provides a summary of the information it received at an April 2021 workshop on the impact of Covid-19 on health inequalities. The Board is asked to identify the actions and/or work streams that they would like to see taken forward.

The Board considered a report which provided a summary of the information it received at an April 2021 workshop on the impact of Covid-19 on health inequalities. The Board was asked to identify the actions and/or work streams that they would like to see taken forward. The Consultant in Public Health – NHS Vale of York Clinical Commissioning Group was in attendance to present the report.

Key issues raised in the presentation of the report included:

·        That deprivation levels are useful in highlighting health inequalities, for example over the past decade the gap in life expectancy between the richest and poorest groups in society have widened and life expectancy increases have largely stalled in 2011/12. The ‘inequality cliff edge’ was discussed, wherein the most disadvantaged in society have a significantly lower life expectancy than those in the next higher percentile.

·        Issues reported since the onset of the Covid-19 pandemic included an increase in perinatal mental health conditions; carers who are working with fewer breaks and increased isolation; increased poverty around technology, with some without the means to pay for broadband or smartphones; the increased risk of exposure of those with multiple complex needs to Covid-19; limited social contact amongst the elderly leading to increased loneliness and an increase in poor mental health amongst the Traveller community.

·        That there were three layers/causes to health inequalities as identified by the Department for Health and Public Health England: attributable risks, causes and causes of causes.

·        Feedback from the workshop, which highlighted both York’s greatest challenges and assets, as well as how to protect the next generation, with the first 1,001 days of a child’s life, from conception to around two years old, being one of the most critical for long term health.

·        The Marmot Framework was especially emphasised as a means of producing a fairer and healthier society.

Key points arising from discussion of the report included:

·        That the exemplar city around the Marmot Framework was Coventry, who have adopted it as a city-wide framework in all areas, not just in health and wellbeing. It was suggested that some collaboration between York’s and Coventry’s Health and Wellbeing Boards in future could be looked into.

·        The importance of the first 1,001 days of a child’s life in improving long term health was emphasised by multiple Board Members, with a need for increased discussion of maternity services and more work around pre-conception care also highlighted. Furthermore, it was noted that a whole-family approach was needed on this issue.

·        That a key failure in York’s health services had laid in co-production: that was not enough engagement with local residents around their needs. The Manager of Healthwatch York out herself forward as a sponsor of work to improve and develop new ways of co-production in the city as part of a partnership between Healthwatch York and York and Scarborough Hospital to create a Voice and Lived Experience Collaborative.

·        In response to queries around availability of and changes to access in the primary care sector, it was noted that the move to a more clinical approach since the pandemic began had many advantages, and that despite staff shortages and the effects of the pandemic, there were now more contact points in the primary care sector for patients than before the pandemic, however it was acknowledged that the demand for primary care services had increased faster than supply.

·        It was reported that Healthwatch York was preparing a report on health inequalities which would be conducted in a sensitive manner, recognising both patient and professional issues.

·        The importance of the effect of climate change on health inequalities at present and into the future was noted.

·        That a 20-year plan on health inequality was needed which addressed the previous mentioned attributable risks, causes and causes of causes in turn.

·        Multiple Board Members noted that the pandemic and the impending restructure/reform of health services presented an opportunity for the Health and Wellbeing Board to reposition itself within the city as a system leader driving the economic, climate change and other strategies of York.

The Executive Member for Children, Young People and Education spoke on the YorOK Board, which was last due to meet on Tuesday 17 March 2020 before meetings were suspended due to the Covid-19 pandemic and lockdowns. The Executive Member gave notice that it had been provisionally agreed to stand down the YorOK Board and replace it with a new board/partnership with broadly similar membership and objectives, but a more direct reporting line to the Health and Wellbeing Board

Resolved:

(i)           That the workstreams that the Health and Wellbeing Board would like to see progressed are:

-      The repositioning of the Board as a strategic leader across all areas of work in York.

-      The creation of a 20-year strategy to combat health inequalities.

-      Ensuring that all children get the best possible start in life, especially around the first 1,001 days from conception and pre-conception.

-      Work around co-production.

(ii)         That the Chair, Vice-Chair and Director for Public Health will discuss how best to progress these workstreams.

Reason: To ensure that work happens to reduce health inequalities within the city.