Agenda item

This paper provides an update in relation to health inequalities.

*Clerk’s note - due to the availability of the speakers, the JHOSC agreed to amend the order of the agenda items: to take the Health Inequalities item first, then Missing Cancer Patients, then Digital Inclusion. The minutes reflect the order I  which the items were discussed.*

The Committee received a presentation on Addressing Health Inequalities from the Ruth Donaldson, Director of Communities for North Central London Clinical Commissioning Group (NCL CCG). The presentation was set out in the supplementary agenda pack at pages 45 – 76. The following arose during the discussion of the presentation:

a.    The Committee sought assurances around the low uptake of vaccinations within vulnerable and minority groups. In response, officers acknowledged that there was trend of lower uptake levels amongst a number of communities who were at risk of inequalities. Officers advised that they working with specific groups who had low uptake rates and had held a series of open community meetings. A number of targeted community events had also taken place in different languages and adverts had also appeared on Somali language TV, for example. NCL staff had also been working with organisations such as Groundswell to reach the homeless cohort.

b.    The Committee expressed particular concern for the relatively low uptake rate amongst social care staff and queried why this might be. In response, officers advised that an Enfield Healthwatch report had set out that a historic mistrust of public services from certain communities was a key factor. It was suggested that this should be characterised as hesitancy rather than refusal to be vaccinated and that a lot of work was going on to provide information and additional assurance around this.

c.    The Committee queried what new initiatives could be undertaken around health inequalities and how could local councillors be involved in these. The Committee welcomed any opportunity for local councillors to be involved in decision making. In response, the Committee was advised that there were a number of ideas for anticipatory care models including ‘ageing well’, which were about putting more prevention into people’s care and more resources into deprived areas. Although need and budgets were compiled at a central NCL level, officers outlined a model used in Leicester were local areas bid for funds and individual schemes. It was envisaged that the development of a NCL population health committee would be one of the opportunities that could arise from moving to an Integrated Care Partnership.

d.    In response to a request for clarification, it was confirmed that the colours in the indexes of deprivation in the presentation highlighted the top 20% and that the fact that Barnet was only shown in the fuel poverty index was accurate.

e.    The Committee commented that it was not necessarily the NHS’s fault that historic mistrust in health services and vaccines existed from some people who may come from parts of the world where there were good reasons for that mistrust including corruption. It was queried the extent to which socio-economic factors played a role in access to health care given that health care was free. It was suggested that there were a range of other factors at work such as the relationship between childhood obesity and indices of poverty. In response, NCL acknowledged concerns around the uptake of vaccines in certain communities but suggested that it was not a straightforward as suggested and that there were differential take-up rates between Black British demographic groupings and White British demographic groupings. It was highlighted that there were concerns about disproportionate access rates to services and it was hoped that the community participatory research would help elucidate this further.

f.     The Committee welcomed the work done in the presentation overall to link health inequalities to poverty and highlighted disproportionate inequalities around BAME access to mental health services and a paucity in the availability of talking therapies in particular. In response, NCL officers advised that one of the key issues was the massive disproportionate access to severe mental health services for young black males in Edmonton and north Tottenham and their disproportionate access to talking therapies. Officers commented that it wasn’t just about provision, it was about the stigma attached to accessing those services.

g.    In relation to the role played by factors other than deprivation, NCL officers outlined that digital exclusion was a key factor and that this predominantly affected the elderly population. However, deprivation would likely impact the ability for a young person to own the required equipment, even if they had the knowledge and skills to use it.

h.    The Committee emphasised the importance of some of the stories behind the data and how that added a richness to understanding some of the problems discussed. The Committee queried disproportionate access for some deprived areas to GP surgeries. In response, officers acknowledged these concerns and set out the need to provide system level responses but ones which were delivered locally.

i.      The Chair requested that this item came back to a future meeting and the Chair would pick this up with Ruth Donaldson offline. (Action: Cllr Connor).

RESOLVED

That the update in Addressing Health Inequalities was noted.