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Health of the Region 2020

Section 3 - Commitments to action and recommendations

Public Health England has produced two significant reports on the impact of COVID-19 on particular communities Its first report confirmed that COVID-19 has replicated and, in some cases, increased existing health inequalities And in its report on BAME communities, it identified a number of reasons why death rates have been significantly higher amongst Black and Asian ethnic groups Both reports emphasised the role of prevention through improving the wider determinants of health, and more equitable access to health and wider services

This is in line with the issues highlighted by WM Citizens’ Panel, which identified accessing healthcare and improving physical health as key components of community recovery Alongside concerns about how to keep safe from coronavirus, panellists were particularly concerned that the healthcare system could get back on track to diagnose and treat people They also identified the importance of preventative issues – promoting healthy living to reduce demand on services and tackling the deeper causes of poor health.

This final section of the report is framed around 4 big challenges that arise from this analysis

  • We must begin with the urgent task of improving outcomes for BAME communities Targeted and immediate action to tackle structural racism is an urgent and immediate priority
  • But lasting change will only happen when we take a systemic approach to tackling the wider determinants of health and dealing with the structural inequalities we find in our economy, housing market, education, justice and transport systems
  • Similarly, we must tackle inequalities in the health and care system and widen access to health and care services This requires a fundamental rebalancing of funding and focus on primary and preventative care
  • These challenges, in turn, will create the conditions in which people-powered health can flourish and healthy lifestyles can become the norm

The 4 challenges are set out in the diagram below:

  • Improving outcomes for BAME communities
  • Tackling the wider determinants of health
  • Widening access to health and care services
  • Enabling people-powered health

In the final section of this report, we take each of these challenges in turn and address two responses:

  • Commitments to action – these are the activities that key stakeholders in the region are already undertaking, or are planning to undertake, that are seeking to address the challenges that have been identified – these are divided into commitment on the part of the WMCA and commitments made by other stakeholders

  • Recommendations to government – these are changes required of central government in order to unlock change in the region

 

Improving outcomes for BAME communities

This report has shown clear evidence that the coronavirus pandemic has both exposed and exacerbated longstanding inequalities affecting black and minority ethnic (BAME) groups The risks of catching COVID-19 and dying from it have been shown to be higher for BAME groups than in White ethnic groups There are several inter-related factors that might contribute to this disparity Individuals from BAME groups may be more likely to suffer from other chronic conditions; they are more likely to work in occupations with higher risk to COVID-19 exposure and more likely to use public transport to travel to their places of work; and the risks of transmission and morbidity can be exacerbated by the housing challenges faced by some members of BAME groups Pervading all of this, BAME communities experience systemic discrimination and racism on a daily basis which directly affects physical and mental health and has been shown to affect access to health services

A whole-system approach to responding to and recovering from COVID-19 must address these issues head on All public institutions need to monitor and evaluate the extent to which systemic discrimination affects their services and working practices BAME groups must be better represented in their workplaces and NHS and other health and care bodies should commit to relevant race equality standards.

WMCA Commitments

  • The WMCA’s independent Leadership Commission will make advancing opportunity and mobility within the health and care sector a key priority in its new implementation plan and work with partners on action to achieve this

  • WMCA will develop a targeted Thrive mental health programme co-designed with BAME employers and employees

  • WMCA will carry out rigorous equalities impact assessments of all of its directorates and wider agencies

  • WMCA will hold Mayor’s WM BAME roundtable meetings every 6 months to monitor steps that been taken by WMCA and wider regional partners in relation to the Health of the Region commitments to action

Partner Commitments

  • The new multi-agency Midlands System Transformation Recovery (STaR) Board will carry out an evaluation of regional NHS programmes through a Black Lives Matter and post-COVID lens

  • PHE West Midlands will develop a BAME and Disparities workplan to ensure improving health outcomes for BAME communities is a cross cutting consideration across priorities of health and wellbeing programmes; and undertake analysis to determine the extent of inequalities and impacts of COVID-19 on black and minority ethnic communities

  • Black Country and West Birmingham CCG Equality & Diversity leads group across the BCWB STP to ensure a consistent and unbiased approach in supporting BAME colleagues and delivering BRAP training for all STP board members The Health Inequalities and Prevention Board will also improve our ethnicity data collection and use of ethnicity data and work to understand and address inequalities between different ethnicity groups

  • Royal Wolverhampton NHS Trust is committed to making progress on the Workforce Race Equality Standards (WRES) and are currently on track to meet the 2028 target for leadership diversity

Birmingham and Solihull STP will:

  • Routinely produce data to support restoration and recovery broken down by sub-analyses of socio-economic factors, including ethnicity and levels of deprivation

  • Deliver various initiatives to support people with diabetes, including a marketing
    plan being developed with our BAME diabetes patient champions and provider Weight Watchers (WW), to be delivered in communities and in different languages

  • Implement the NHSEI perinatal mental health support for BAME women

  • Recruit a STP Inequalities Lead, STP Workforce and Inclusion Director and STP Workforce and Inclusion Convenor to support delivery

  • Solihull Metropolitan Borough Council will work to adopt the PHE Heat Tool as part of a health in all policies/integrated Equity assessments across Council

  • Dudley Group NHS Foundation Trust will launch a health and wellbeing strategy for staff, supported by their BAME inclusion network, which provides a 12 month calendar of culturally appropriate health and wellbeing initiatives to support staff from a physical and mental wellbeing perspective

  • Aston University is developing ‘Inclusive Aston’ which includes working towards a Race Equality Charter award

  • West Midlands Police are working to look more like the people they serve and have set a target of recruiting 1,000 BAME officers over the next three years

  • The Walsall Together Partnership is committed to the Workforce Race Equality Standard and seek to hear BAME views through engagement and through Walsall for All and Healthwatch partners

  • Health watch WM will conduct targeted work to gather views and experiences of patients and the public, especially from underrepresented groups

  • The West Midlands Fire Service will continue to take positive actions and make the the service more representative of the communities they serve

Widening access to health and care Health of the Region 2020

The responses to our call for evidence have brought into sharp focus the inequalities in healthcare provision caused by disparities in access to good quality healthcare, especially for poorly managed conditions in vulnerable groups Lockdown has made things considerably worse as the NHS seeks to deal with a significant backlog of non-COVID related morbidity and it is likely that the effect of this will widen existing health inequalities and lead to avoidable cancer death as a result of diagnostic delays Across the UK it was estimated that by August 2 1 million people have missed out on screening, while 290,000 people with suspected symptoms have not been referred for hospital tests.

And this is just cancer Other concerns include access to mental health services (see next section); the future of care homes and domiciliary care; and the implications of moving towards a system that relies more heavily on ‘telehealth’

‘Recovery’ presents the opportunity for a radical rethink of the ways in which people access health and care services Primary care services could be much better integrated within local neighbourhoods with clinics, pharmacies, housing officers, voluntary and community groups working together as we have seen in the crisis – particularly focusing on those who most need support and access We need to exploit the opportunities created by the switch to virtual consultations and ramp up digital screening services but in doing so place a big focus on supporting those who don’t have digital devices or good connectivity or the confidence and skills to make the most of telehealth services And we need a new vision for adult social care, addressing the crisis facing the care home sector and finding new ways to support people to live at home with connections to their wider community.

WMCA Commitments

  • WMCA will train and support healthcare professionals to refer disabled citizens to physical activity as part of its IncludeMe initiative

  • WMCA will amplify its Thrive into Work programme to a further 450 people living with poor mental and physical health It will focus on those out of work and those at risk of leaving employment due to their health condition

  • WMCA will continue to support the utilisation of transport hubs as digital screening centres and for ‘pop up’ heart / CV checks, breast screening, sexual health etc

Partner Commitments

  • The new multi-agency Midlands System Transformation Recovery (STaR) Board will ensure that the differential experience of access and delivery of services is an intrinsic part of service design and evaluation

  • PHE West Midlands have carried out a WM- wide needs assessment and literature review to inform regional and local commissioning of language and interpreting services in the West Midlands and informed commissioning of an interpreting service for the Health Protection function in the West Midlands

  • University Hospitals Birmingham will use digital transformation to reduce health inequalities by enabling people to access health care and information in a more accessible and a timely way and ensure its staff are advocates for digital inclusion including creating community diagnostic hubs in local neighbourhoods

  • Black Country and West Birmingham CCG will develop an Academy to provide population health management capacity to the system It is developing a number of population health management projects that will widen access to health and care including early diagnosis of cancer in vulnerable groups

  • Aston University would like to develop a Health Hub at Aston that would be open to the local community

University Hospitals Coventry and Warwickshire and Coventry University want to develop a community diagnostics centre in the city centre that would improve access to such facilities to the local community

Healthwatch WM will provide advice and information about access to services and support for making informed choices

Walsall Together Partnership will understand the inequitable take up of health and care services and working through the Partnership and wider community networks to address the causes

Birmingham and Solihull STP will develop population health management within Primary Care Networks (PCNs) and ensure its primary care estate is under one digital domain by March 2021 promoting digitally enabled care for staff to work together in virtual multi- disciplinary teams

The Dudley Group NHS Foundation Trust will commit to working with colleagues in Dudley to explore how to collectively make a difference to cancer outcomes, with a particular focus on parts of the Borough where outcomes are poorer This will include ensuring screening services provided by the Trust are delivered
in a way which encourages uptake from more vulnerable people and how cancer services are culturally sensitive and more person centred

The West Midlands Fire Service, as a key part of their Safe and well visits, will refer people on to other partner agencies to gain access to services that can tackle wider health and care issues

People-powered health

The coronavirus crisis has reminded us all of the importance of our own physical and mental wellbeing Not only have we seen the clear relationship between having pre-existing health conditions and the risks of dying from the virus, lockdown has reminded many people of the benefits of daily exercise and how an appreciation of nature can be so good for our mental health This apparent silver lining is something we should not lose How we all look after our physical and mental wellbeing must be central to community recovery.

People-powered health is an approach to wellbeing that puts people and prevention first This could be as simple as encouraging people to walk or cycle more through safer streets and active travel schemes It involves initiatives to tackle childhood obesity, build public awareness about healthy eating and tackle food poverty in poorer neighbourhoods As we look forward to the Commonwealth Games it means making sure there is a clear legacy around sport in the community and physical activity But it also involves putting people at the heart of decision-making and the co-design of our health and care services.

WMCA Commitments

  • WMCA will continue to develop its Include Me WM programme to engage disabled people and people with long term health conditions to be physically active

  • WMCA is committed to increase cycling from 3% to 5% of mode share by 2023 through
    the delivery of the WM Cycling Charter and extending cycling and walking routes

  • WMCA will work with other Commonwealth Games Delivery Partners to develop a long lasting physical activity and wellbeing legacy for the region

  • WMCA will endorse a Making Every Contact Count approach amongst its employees
    and encourage and influence other anchor institutions / businesses / employers to support people-powered health in their workplaces

  • WMCA will standardise inclusion of social value in our single commissioning framework MoU’s to include Wellbeing and work together to maximise and measure outputs in the communities that we work in

  • WMCA’s Young Combined Authority Board will continue to encourage and challenge the West Midlands Combined Authority and its partners to listen to the voices of citizens when shaping policies which will affect their lives

Partner Commitments
  • PHE West Midlands are working with national colleagues and NHS Midlands advocating for community centred and asset based approaches, providing resources, tools and products to enable ‘people-powered health’ including support and leadership for the Regional Social Prescribing Network, promoting the role of the NHS as an anchor institution, maximising opportunities through volunteering (including PHE staff role modelling this) and landing social marketing campaigns
  • Black Country & West Birmingham CCG PCNs will have recruited 63 social prescribing link workers, 38 care coordinators and 12 Health and Wellbeing Coaches by March 2021 and plan to recruit more than 200 posts by March 2024 These new roles focus on people-empowered health The learnings from the Personalised Care Demonstrator site are being embedded in our workstreams 9 PCNs are joining the Dartmouth PCN development programme in 2020/21
  • Birmingham and Solihull STP will support behaviour change for staff and community leaders through various wellbeing initiatives including a targeted campaign on flu vaccination with a focus on the most vulnerable and those disproportionately affected by COVID-19.
  • The West Midlands Fire Service will continue use the incentive of firefighting as a means of tackling wider health and wellbeing issues for young people through their programme of Fire Cadets The service will also utilise their schools education and work at Safeside to tackle wide range of safety, health and wellbeing issues that underpin long-term risk of fire
  • Black Country Consortium is supporting the ‘Tribe Project’ - a social prescribing campaign, supporting prevention and increase community resilience; and supporting a whole system approach to reducing childhood obesity from early years through to secondary schools
  • Aston University are working in partnership with Aston Villa Foundation to go into local schools to deliver workshops about eye health, conduct eye screening and eye tests for those that need it, and working with children and parents on childhood eating habits
  • Coventry University will create a number of fully funded PhD studentship opportunities which focus on themes related to COVID-19 and the post- pandemic future
  • Healthwatch WM will promote and support involvement in commissioning of health services and provision of care services
  • The Walsall for All Board will raise public awareness about the support available to improve mental and physical wellbeing through the Walsall Together partnership
  • Police and Crime Commissioner (PCC) have re- established police cadets to support young people and reduce inequalities In addition, the PCC and West Midlands Police are rolling out units in our most diverse and challenging areas, focusing on young people who need the most support

Recommendations to Government

Improving outcomes for BAME communities

  • Government should produce a clear and comprehensive action plan setting out how it will work with local and regional partners to take action on race disparities and associated risk factors

  • Government should commission further data, research and analytical work at the local and regional level to understand the geographical and place dimensions of race disparities in health

Tackling the wider determinants of health

  • The NHS should make local action on tackling health inequalities the focus of the NHS ‘Phase 4 Letter’ on Covid19

  • Government should make health and well-being outcomes a key driver of economic development and levelling-up policies including industrial strategy and local industrial strategies; the UK Shared Prosperity Fund; Towns Fund; and future devolution deals

  • Government should double the proportion of health and social care spending focused on prevention and public health from 5 to 10 percent over time

Widening access to health and care
  • Government should ensure that Local Authorities have sufficient powers
    to improve public health and reduce health inequalities, with Mayoral Combined Authorities providing support where they can add value (Devo WP Submission)
  • Government should support the WMCA’s proposal to establish digital screening hubs in high footfall transport locations
  • Government should do all it can to close the gap in primary care provision between the most and least deprived neighbourhoods in terms of funding per patient and serving GPs
  • Government should look to widen its plans and increase its investment to tackle digital poverty with a particular focus on those who do not access health and care services online
People-powered health
  • Government should invest in the WMCA’s Radical Health Prevention Fund to drive forward innovation, social prescribing and other initiatives to tackle health inequalities in the region
  • Government should pilot the Kruger report’s Community Right to Serve provisions for health and social care in the West Midlands 111
Tackling the wider determinants of health

In order that we might be more resilient to future pandemics, we need to make sure we create a society in which everybody can lead a healthy lifestyle This means looking not just at the causes of ill health, but the causes of the causes: getting a good start in life, educational attainment, our jobs and incomes, our homes and where we live, our friendships and sense of purpose and belonging These wider determinants of health have been shown to be the main drivers of health inequalities which in turn have led to some communities being more badly affected by COVID-19 than others.

In responding to and recovering from the pandemic, the health and wider system must put a strong focus on these root causes Perhaps one of the most important initiatives though that will help to achieve this is through a Health in All Policies (HIAP) approach HIAP encourages every public agency to consider the health implications of every decision it takes to find opportunities to promote wellbeing, avoid causing harm, and reduce inequality between groups Another initiative to encourage this systemic approach would be to become a Marmot city region to galvanise our shared commitment to preventative health and wellbeing and build a more collaborative system for achieving it.

WMCA Commitments

  • WMCA will work with partners to become a Marmot City-Region and develop a 3-year action plan for change

  • WMCA will incorporate a Health In All policies (HIAP) approach into its Inclusive Growth Framework

  • WMCA will continue to pay the Real Living Wage and ensure its contractors do so too

  • WMCA will target underrepresented groups for training programmes to support access to jobs, particularly where groups are under-represented in the workforce – for example, our work with Black CodHers helps black women gain digital skills and careers

  • WMCA will capture health outcomes in our zero- carbon initiatives

  • WMCA will work closely with public health colleagues on planning applications to embed public health expertise within our Housing and Land team

Partner Commitments
  • The new multi-agency Midlands System Transformation Recovery (STaR) Board, working with PHE WM, will establish a Health Inequalities Working Group which will:

  • support Integrated Care Systems to plan and be held accountable for addressing health inequalities within the populations they serve;

  • provide standards, guidance and tools to ensure health inequalities are considered in the design and evaluation of new NHS services

  • NHS Confederation has called for both local authority and NHS commissioners to work with wider system partners to integrate and embed employment support alongside clinical services to improve access, integration and visibility of employment support

  • Birmingham and Solihull STP are implementing a system leadership programme for 500 leaders who will receive • bespoke learning on meeting the needs of vulnerable citizens and tackling key inequalities It will also support vulnerable people through shielding, particularly in the context of a local ‘lockdown’, with additional support delivered through our partner organisations

  • The Police and Crime Commissioner (PCC) will continue to work with partners to identify additional opportunities for intervention and prevention in reducing the harm caused by drugs, gangs and violence For example, the New Chance programme provides a whole system approach to keep low level female offenders out of the criminal justice system

  • The directors of public health share the ambition to reduce health inequalities and address the wider determinants of health In particular, they are committed to working with partners and the WMCA

The Dudley Group NHS Foundation Trust will commit to working with partners including the Local Authority and Dudley College to explore how they can ensure more employment opportunities for local people, in particular those who have found it hard to get employment in the past

WM Violence Reduction Unit keep a continued focus on reducing inequalities through the place-based pilots, and through a new inequalities ‘champion’ who will work closely with theme leads, the data analytics team and the commissioning lead to embed efforts to reduce health inequalities systematically across the VRU

WMCA Homelessness Taskforce will develop a Commitment to Collaborate toolkit to prevent and relieve homelessness, which will provide a framework to tackle the systemic inter-related issues which drive homelessness and work closely with health colleagues to provide access to health related interventions for those with poorest access

University Hospitals Birmingham will work with CLES and Pioneer Housing on a project to retrain hospitality workers to work within UHB hospitals

to address these disparities through inclusive growth, leadership and coordination

  • Black Country and West Birmingham CCG Health Inequalities and Prevention Board has a Wider Determinants sub-group which steers the Wider Determinants of Healthy Life Expectancy (WHoLE) programme Phase 1 of the programme has just completed and Phase 2 will design, appraise, implement and evaluate interventions
  • The West Midlands Fire Service will focus on tackling the wider determinants of health during their Safe and Well visits as they are also the underlying causes of fire risk

  • The Black Country Consortium will work with developers on the incorporation of the Black Country Garden City principles into future housing pipeline

  • Sandwell and West Birmingham NHS Trust are committed to deploying a minimum of 2% of its future annual budget with local suppliers and to paying all staff at or above the ‘living wage’

  • The Walsall Together partnership will ensure that Housing, the Community and Voluntary sector is represented on the Partnership alongside health and other statutory partners and that its plans are informed by evidence of the holistic needs of the population

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