Agenda item
BAME Communities and the Impact of Covid 19 in Brent
This report considers the impact of COVID-19 on BAME Communities in Brent.
Minutes:
Councillor Neil Nerva (Cabinet Member for Public Health, Culture and Leisure, Brent Council) introduced the report which provided an overview of the underlying causes of the patterns of infection and mortality from Covid-19 among Brent’s Black and Minority Ethnic (BAME) communities. Councillor Nerva pointed to report paragraphs 6.8.1 onwards regarding community health meetings that had taken place the previous week with community leaders in Church End and Alpterton. There was a proposal to create Community Champions roles for outreach in those communities.
Dr Melanie Smith (Director of Public Health, Brent Council) noted when thinking about the disproportionate impact of Covid-19 on BAME communities it was important to think about the potential causes, such as occupational exposure, increased susceptibility to severe infection from underlying health conditions and access to appropriate healthcare, and Brent’s possible response to those regarding exposure to the virus. Dr Melanie Smith acknowledged the entrenched structural inequalities within society and expressed that there was a need to act in the immediate and longer term, with immediate actions aimed at reducing exposure to the virus, increasing resilience and ensuring access to healthcare.
The Chair thanked both for their introduction and invited questions from the Committee, with the following issues raised:
The Committee queried what actions would be taken forward as a result of the findings that BAME communities were disproportionately impacted by Covid-19. Dr Melanie Smith advised they would be acting to reduce the exposure of BAME communities to the virus. For example, Public Health England research had shown that national messaging was not culturally competent therefore Brent had developed local messaging and were part of the ‘keep London safe’ campaign which had produced materials more appropriate for a diverse London population. The Council wanted to work with the community and engage Community Champions to ensure messaging was reaching all communities effectively. Dr Melanie Smith expressed it was important the Council worked with the community to develop the action plan rather than presenting an action plan produced for them, as Public Health England qualitative research showed many BAME communities felt disempowered.
Further discussing the action plan, the Committee heard that the Council and health colleagues were reducing exposure by getting people tested and self-isolated. There was a hyper-local walk-in testing site in Harlesden which had adapted the national model to ensure it was accessible to local people, and increasingly those getting tested at that site were reflective of the ethnic diversity of the communities who lived there. It was also highlighted that BAME communities were more susceptible to severe levels of infection, some of which was associated with higher levels of diabetes, hypertension and cardiovascular disease in those communities. Dr Melanie Smith explained that there was evidence those conditions, if poorly controlled, contributed to worse outcomes. The Public Health department were working hard with Brent Clinical Commissioning Group (CCG) to ensure people with those long term conditions were contacted and helped to maximise the control of their condition in preparation for a second wave. Work on the flu vaccination programme had also begun to increase resilience, and NHS colleagues were working with the Local Authority to look at new models of primary care, and would be piloting those models in Church End and Alperton. Dr MC Patel (Chair, Brent CCG) added that primary care clinical directors and operational managers were looking at the government provided shielded list in Brent and had made the decision to include more people on that list to ensure appropriate advice was going to more people. The list would be extended to include BAME communities and people with associated co-morbidities, who were not necessarily on the government list. Dr Melanie Smith acknowledged that some factors associated with increased exposure to the virus in BAME communities would not be possible to action in the short term and required long term focus, such as overcrowding and housing issues which were very important issues to address.
In relation to the meetings with Church End and Alperton, Councillor Nerva expressed they had been very important to look Brent wide at standards of social distancing and review the methods employed to keep residents safe. The meetings highlighted structural issues for BAME communities, such as housing, jobs and health co-morbidities resulting in people being more at risk and in his new role Councillor Nerva expected to pick these up in the next Health and Wellbeing strategy. Dr MC Patel agreed that the community meetings were an opportunity for health colleagues and the local authority to tackle issues they had known about for years. There was a joint commitment to make things happen in Brent and do things differently.
In response to comments regarding the abolition of Public Health England and the refusal to allow local authorities autonomy over testing, Councillor Neil Nerva stated that it was disappointing but important not to stand back and pass blame. He highlighted there was a need to restore confidence in the NHS so that people were receiving treatment and support.
The Committee asked why BAME communities in Brent were so severely hit by the pandemic. Professor Mala Rao OBE (Imperial College London) explained to the Committee that there had been 2 or 3 fairly rapid investigations into the potential risk factors for the excess and disproportionate impact of Covid-19 on BAME communities, including the ‘Open Safely Collaborative’ which was done by academics in Leicester who specialised in underlying conditions such as diabetes. She expressed that there had not been a large amount of time to understand the novel virus and how it worked, therefore there was not complete understanding, but the work done so far had been impressive. Data sets had looked at thousands of hospital admissions to see what could explain the disproportionate impact, with findings pointing to similar conclusions - that it was likely to be a combination of all the risk factors already discussed. Professor Rao highlighted that those impacted were likely to live in overcrowded circumstances, may be nutritionally deprived, their health physiology was likely to be impacted by micro-aggressions and racism they had encountered through life, and air pollution was worse in urban areas. Those factors reinforced each other and made the impact worse. Professor Rao informed the Committee of research funding opportunities in the UK for researchers with some of that allocated to research groups at UCL and Leicester, and she queried whether any of that research was being conducted in Brent or whether there was an opportunity for the Council to offer to those groups that the research be undertaken in the Brent community. Dr Melanie Smith replied that in Brent they had participated in academic research particularly on the management of diabetes in black communities and would be interested in making links going forward.
Further querying research conducted, a member of the Committee asked whether researchers had looked at countries of origin and whether Western diseases experienced in BAME communities with higher co-morbidity were also experienced by those in their countries of origin. Dr MC Patel agreed that it was useful to look at other countries and there was learning that could be taken but felt that was a longer term approach and enough was already known to protect people quickly and effectively, as there was a present and clear danger and a need to ensure practical solutions were in place. This would be done through effectively communicating with all communities in the Borough.
The Committee heard from Veronica Awuzudike (Healthwatch Brent Manager) that some residents of BAME communities felt the communications being received were not as clear as they could be. Queries were raised as to the level of engagement with different communities and whether it was sufficient to mitigate mass deaths. Dr MC Patel agreed that going forward the most important thing would be ensuring engagement with communities and community leaders that would help deliver messages to all the diverse communities in Brent. He hoped through the work with the 10 practices in Church End and Alperton they would gain a better understanding more rapidly of the needs affecting those communities. Robyn Doran (Chief Operating Officer, Central and North West London NHS Trust) explained that she had taken learning from working with the Grenfell community and applied it to her work in Brent as part of the Working Group on health inequalities. She noted the importance of directly involving the community affected by the issue. She had personally met community leaders in the Somalian community in Church End with Dr MC Patel and in partnership with the Local Authority and heard that people felt they did not have the right information on Covid-19. Community leaders wanted to co-design training with infection control nurses delivered to the community, and they had commissioned local tailors working with nurses to make masks community leaders could distribute. The Working Group was also working with faith leaders and the third sector.
The Committee highlighted that the BAME communities that had been hit hard across Brent may also experience other difficulties which could be contributing factors to the impact of Covid-19 such as language barriers and poor access to GP services. Councillors shared their experience of speaking with BAME residents who were scared to go into hospital and had no access to GPs who were not answering phone calls and had queues outside of practices. Dr MC Patel agreed that many people were scared to go to hospital for fear of contracting the virus and there was a general view access could be improved. He offered to join Councillors to talk to communities in small groups of 5, adhering to the Covid-19 guidelines, to gain feedback and take actions to improve access. Councillor Nerva hoped that the Committee would seek a further report on communications with the next report demonstrating measurable differences.
The Chair thanked the Lead Member and Officers from Public Health and the NHS for their contributions and drew the item to close.
Supporting documents: