Agenda item

To provide an overview of the £5m health inequalities fund which supports schemes targeted at the most deprived communities in NCL.

Ruth Donaldson, Director of Communities at the NCL ICB, introduced this item, noting that further funds had been allocated since the previous overview that had been provided to the Committee 18 months previously. The original purpose of the scheme had been to develop innovative solutions to health inequalities and some details of the schemes had been provided in the pack.

The schemes highlighted included:

• The ‘Supporting People with Severe & Multiple Disadvantage’ scheme (Haringey) aimed at working with people with compounding inequalities (for example because of their ethnic background or their employment/housing status) and poor health outcomes. The scheme worked across services to offer proactive wraparound care with a small cohort of people which led to a reduction of 800 A&E attendances.
• The ‘Peer Support for Cardiovascular Disease Prevention’ scheme (Barnet) connected people of South Asian, African and Caribbean heritage and had led to reductions in blood pressure.
• The ‘Black Health Improvement Programme’ (Enfield) had included cultural competency training for GPs and the feedback had been positive.

Ruth Donaldson commented that the wider lessons learnt from the programme had included that resources were allocated at NCL level but then Borough Partnerships determined how it was spent based on their local insights and understanding which had led to more collaborative and innovative solutions. In addition, the learning from the co-production and community empowerment work could be applied across the system in future, included by monitoring the level of equity in all standard measures and making the best use of limited resources in decision making.

Ruth Donaldson then responded to question from the Committee:

• Cllr Connor observed that this approach appeared to tie in with the Population Health Strategy for NCL. Ruth Donaldson agreed that there was a definite alignment, noting that the Population Health Strategy had five areas and that they were keen to improve outcomes through the delivery part of the strategy and by spending resource in the areas of highest need.
• Cllr Clarke referred to the smoking cessation programme and asked whether the issue of vaping and young people was being incorporated into the programme. Ruth Donaldson said that this had not yet come forward as a particular need and the evidence in this area appeared to be limited. However, she added that a key part of the scheme was about listening to local populations, including young people, about their priorities and then bringing in national evidence and local public health data to determine the use of resources.
• Cllr Cohen noted that the funding for some of the projects was time limited and asked for clarification on the funding situation at the end of those time periods. Ruth Donaldson explained that there were different reasons why schemes might finish. Some schemes came to end because they could not provide evidence of the intended outcomes. Others were time limited because they had completed certain objectives, such as the project on autism in Camden which aimed to bring lived experience expertise into the development of mental health strategies.
• Cllr Cohen referred to the table in the report which listed Barnet separately as part of NCL rather than receiving allocations as an individual area as was the case with the other Boroughs. He added that there were significant pockets of deprivation in Barnet and suggested that this needed to be addressed through the fund. Ruth Donaldson explained that 70% of the fund was linked to deprivation, based on the 20% most deprived wards, and that this criteria did not apply to wards in Barnet. However, the remaining 30% of the fund applied to NCL-wide schemes which did include Barnet and a focus on pockets of deprivation and other areas of particular need.
• Cllr Revah asked what projects were in place to support the disabled community and requested further details about engagement through the community empowerment and co-design process, including organisations covering issues such as youth justice and food poverty, as set out in the report. Ruth Donaldson said that there was not a specific project aimed at this community directly but that this was dependent on the networks in each Borough and the needs that were identified. There had been involvement with groups such as the Carers Forum on the needs of carers and other organisations were represented in groups such as the Enfield Inequalities Delivery Group which looked at the interdependencies and outcomes by protected characteristics associated with conditions such as diabetes. There had been a particular emphasis on engaging with the highest risk populations. The Community Powered Edmonton scheme was an example of local voluntary and community organisations working alongside statutory services to understand the needs of under-served communities.
• Asked by Cllr Chowdhury about engagement with a diverse range of community groups, Ruth Donaldson said one of the approaches used was to ensure that funding was guaranteed for at least two years if outcomes were met. There had also been work with the communications team to focus more on producing videos in a range of languages which was more likely to reach people than the translation of leaflets.
• Cllr Connor asked how the commissioning of projects had changed based on the recent learning about what had not worked so well. Ruth Donaldson said that one of the biggest challenges had been on the length of time to recruit staff from under-served communities. This had included difficulties in recruiting from the eastern European and Kurdish communities for the smoking cessation and cancer screening projects. Where recruitment was successful, the benefits in outcomes did come through, but in areas where recruitment had been too difficult it had been necessary to look at alternative uses for the resource. The two-year funding guarantee that was previously mentioned had been introduced as a way of improving the situation for smaller community groups.
• Asked by Cllr Connor for further details about the process of partnership working and the evaluation work in this area being conducted by Middlesex University, Ruth Donaldson said that, in some cases, a large number of bids were received for relatively small pots of money. The local insight and innovation of Borough Partnerships was therefore important in helping to determine the best use of resource. The Middlesex University evaluation was looking at 10 projects selected due to the good levels of co-production. This involved an overarching steering group with various organisations contributing to the debate with discussion over different methods of co-production.
• Cllr Connor noted that the recent NHS Confederation report, ‘Unlocking the NHS’s social and economic potential’ was referenced in the agenda papers and observed that this emphasised stronger partnership work which could impact on areas such as housing and food poverty. She asked if this approach would be embedded in the next set of projects and on what the likely funding situation was likely to be. Ruth Donaldson agreed that a greater understanding of the wider determinants of health and root causes of health inequalities was the right direction of travel in this area. There was also a focus on the best use of limited resources with interventions such as smoking cessation typically providing a greater return on investment than secondary care interventions. This needed to be based on local insight as well as public health data.

Cllr Revah proposed a recommendation that there should be more focus on people with disabilities in the next set of projects as they faced a high level of health inequalities which had not been addressed in the report. This recommendation was agreed by the Committee. (ACTION)

Cllr Connor proposed that a further report be provided to the Committee at a future date including details of the outcomes of the Middlesex University evaluation and a greater understanding of how the health inequalities work was being embedded in local authorities. (ACTION)