Agenda item

To receive an update on the work done to tackle health inequalities in Brent through the Brent Health Matters programme.

Councillor Neil Nerva (Cabinet Member for Public Health and Adult Social Care, Brent Council) introduced the item, highlighting that there was an awareness in Brent that there were significant inequalities in how people accessed care and their wider health determinants. The paper demonstrated a range of initiatives that had been put in place since the formation of Brent Health Matters (BHM) to tackle health inequalities in Brent. In particular, Councillor Nerva highlighted the section in the report detailing the factory interventions that had taken place in the workplace through Brent Health Matters’ outreach service, which visited workplaces directly where there were known health inequalities and people at risk. The report detailed some of the learning from those outreach sessions which had found instances of diabetes, heart disease and hypertension and highlighted the need for Brent to have a service that was accessible, informed by issues in the local community, and was able to drill down and work in geographical terms at a micro level to reach the people most in need. He highlighted that, within Brent, the partnership wanted to ensure universal coverage whilst also targeting NHS resources to those with the greatest need and difficulties in accessing mainstream services.

In continuing the introduction, Dr Melanie Smith (Director of Public Health, Brent Council) highlighted that there were 4 pillars to the strategic approach Brent was taking. She explained the term ‘proportionate universalism’, which meant that there needed to be both a universal and targeted offer, with that targeted offer developed with communities rather than done to them. The second pillar was recognising that there was a need to attend to the wider determinants of health, which she felt was exemplified by the work BHM had done in factories. Co-production formed the third pillar, where there was a need to listen and work with communities to understand and act. The final strand was accountability, with not only the traditional examination of differences of health status by age and sex, but explicit examination of how services were being experienced and accessed differentially according to a residents’ ethnicity, deprivation and disability. In relation to what she viewed as unique to Brent, she highlighted a combination of input from the local authority, local NHS, community organisations and the voluntary sector reaching out with a practical and clinical offer which other areas did not offer.

Robyn Doran (Director of Transformation, CNWL, and Brent ICP Director) explained that an important aspect of the programme, which was different to other areas, was that Brent Integrated Care Partnership (ICP) was employing people directly from the local community into teams. For example, Central and North West London University NHS Foundation Trust (CNWL) had a team of Community Connectors, of which 6 were employed directly from the community to reach those communities that it had not been good at reaching in the past. Brent Health Educators and the BHM team were also employed directly from the Brent community.

The Chair thanked officers for their introduction and invited comments and questions from the Committee, with the following issues raised:

The Committee was pleased that the report was clear in outlining what health inequalities were and the steps BHM had taken to get to where it was now to address various issues. However, they felt there was a lack of clarity on benchmarking and data around health inequalities and asked for future reports to incorporate information on where Brent had been in relation to health inequalities, where it was now, and where it needed to be in the future, in the context of the 5 key priority areas identified. Dr Melanie Smith agreed that there was a lack of benchmarking, but Brent was now looking at data in a way that many other parts of the system were not. For example, there had always been an awareness, intuitively and at a macro level, that there were inequalities in levels of hypertension, particularly for those of Black and South Asian heritage, but Brent had only recently been able to quantify those differences. Now, BHM was able to know how much more likely a person was to have uncontrolled hypertension if they were of Black or South Asian heritage and lived in Stonebridge compared to other ethnicities in other parts of the borough. Dr Melanie Smith felt confident that she would be able to return to the Committee in a year having narrowed down those differences to provide further benchmarking and data.

The Committee were advised that the figures in relation to social isolation and loneliness detailed in paragraph 3.16, point 7 of the report were from Census data.

In relation to the data available regarding individual Brent wards, the Committee asked whether there had been any work done to identify ‘pockets’ of wards as having significant health inequalities, particularly in the North of the borough. Dr Melanie Smith explained that, currently, Public Health used standard available data to determine deprivation, based on generally accepted measures of deprivation. She thought the Committee was right to highlight the issue of very small pockets of deprivation or other disadvantage, and explained that this was where the quality of understanding being developed through the work in communities was essential to supplement that standard quantitative data. BHM was finding that newly emerging communities or communities with whom statutory services had very little contact with were hidden in data. John Licorish (Public Health Consultant, Brent Council) agreed that there were communities hidden in the data. He gave the example of the Brazilian community who had attended the vaccination bus in Harlesden during the early years of Covid. Because the BHM team employed people directly from the community who lived and worked in Brent and spoke community languages, BHM was able to pick up a number of problems that were being presented and address them there and then. As word spread, more people from other communities started coming to the bus for other issues such as GP access, housing issues and access to maternity services. As a result of that, BHM then worked with specific charities and community organisations that worked with these small pockets of communities to reach further within those communities to address health need. John Licorish highlighted that Brent had an ever changing, diverse population so this was a continuous process.

The Committee asked how BHM could demonstrate co-production work and its impact. They highlighted that one of the key learnings around health inequalities was that they were underpinned by medical mistrust, and they asked how that improved trust was being measured. Nipa Shah (Brent Health Matters Director) highlighted that co-production was measured with a participation ladder, ranging from organisations BHM simply provided information for to organisations with whom BHM was genuinely co-producing with. This was shared on a monthly basis with the Executive Group. BHM now had contact with around 400 organisations. In relation to measuring trust, Nipa Shah explained that it had been approximately one year into the BHM programme when the team started looking at particular impacts. She thought that if BHM had done a survey right at the beginning of the programme it would now have some good comparable data and could do another survey to demonstrate that improved trust, but unfortunately this had not been done. Now BHM was planning to send a survey to all community organisations asking whether they believed this was the right way to work with them and if they felt their community’s trust in health services had improved.

As the report identified Stonebridge as an area in Brent with one of the highest levels of deprivation, the Committee asked if BHM had a plan to level up Stonebridge through greater allocation of resources, including funding. Robyn Doran explained that Brent ICP was trying to use all the resources within it and its partners to wrap services around communities with high level of deprivation, using its influence to target resource on particular communities.

The Committee identified that the performance of the BHM programme was highly dependent on the reliability and granularity of the data collected on health inequalities. Some members were concerned about data in areas that bordered the borough. For example, in Kilburn, the ward bordered Camden and Westminster, meaning some residents were in at least 2 Integrated Care Boards (ICBs) and 3 Primary Care Networks (PCNs), which were the principle data collection agencies. For this reason, some Kilburn residents were not being recorded on Brent data which the BHM programme was based on, which members highlighted had implications for funding and service provision. Tom Shakespeare (Managing Director, Brent ICP) reassured the Committee that Brent ICP had access to all GP data across NWL ICS. The particular issue being raised, where Brent ICP would not have access to data, was where Brent bordered other Integrated Care Systems (ICS), such as North Central London ICS in Kilburn where the ward bordered Camden. Brent ICP recognised there was a particular issue there, and had raised the issue at an ICB level and would continue to raise the issue to see what more could be done to gain access to that particular practice data. Operationally, he felt that Brent ICP had a fairly good understanding of the community given the depth of knowledge into communities BHM had developed. Councillor Nerva added that the point about data from the particular medical centre in Kilburn had been raised at MP level.

The Committee asked what happened when the BHM team visited communities and discovered emerging neurological conditions such as dementia and Parkinson’s. Dr Melanie Smith advised the Committee that the 5 clinical areas detailed in the report were national priorities, which BHM agreed were important and contributed to the burden of ill health and health inequalities, but the approach locally was to listen to communities and not only to respond to top-down approaches from NHSE. She highlighted that there had not been a large amount of work done looking at neurological conditions, which might be something to address in the future, but there were some good examples of where communities had been listened to and priorities had changed as a result, such as with the men’s health work led by John Licorish. John Licorish expanded on that work, explaining that, initially, when Public Health had been researching Covid, they had been looking at risk factors, working with residents and delivering webcasts and talks with various groups to build trust within communities. As that trust developed, a lot of feedback was received and through that feedback the Public Health Team learned of concerns around prostate cancer, particularly for men of Black Caribbean heritage. Men of Black Caribbean heritage felt that the same level of attention had not been given to prostate cancer as, for example, breast cancer, and asked if it was because this cancer was more prevalent within Black Caribbean communities where outcomes tended to be worse. Public Health started to hear those concerns and from that launched a men’s health programme, co-produced with men from different communities and working with local charities that had particular focus on prostate cancer. Initially that programme had small numbers, but, over time, the numbers grew, and from that programme there was a very clear demand for the local area to provide PSA testing for prostate cancer. He felt this was a very clear example of how the community were listened to and action implemented following that.

In relation to asylum seekers, the Committee asked if there was any specific work BHM was doing to address their health needs and their ability to portray their health if English was not their first language. Dr Melanie Smith explained through the partnership there was a co-ordinated response from the Council and NHS to address the needs of those living in contingency accommodation.

The Committee noted the ambition to increase the number of children receiving immunisations in paragraph 3.63 of the report, and asked how BHM would approach that, given the mistrust in the community towards vaccinations. Dr Melanie Smith explained that she was a passionate advocate for immunisations, which she felt were fundamental for health improvements worldwide. However, she acknowledged that Brent would not achieve their immunisations ambitions if residents were continuously lectured about immunisations, so she highlighted the importance of truly listening to communities to understand their concerns and being there for them. BHM was trying to persuade the NHS to consistently come into Brent communities to offer access to immunisations, rather than a one-time offer, which was felt to be key.

The Committee asked what other departments were being engaged in the health inequalities work and how. It was highlighted that the workstream covered class, race, poverty, disability and deprivation levels and looked at housing, social care and fed into the Black Community Action Plan (BCAP) which covered multiple departments. Dr Melanie Smith confirmed that BHM was working across the Council on health inequalities, but there was a particular focus specifically within Care, Health and Wellbeing. BHM was now looking to focus on Children & Young People, subject to a successful funding bid, which would require close working with that department. She felt it was important that joint work encouraged departments to also consider universal and targeted interventions that would help to tackle inequalities. As an example of cross-departmental work, Dr Melanie Smith highlighted the work done with the Parks department which focused on access to green spaces and play facilities and access to green spaces and play facilities for children with disabilities, which was both a universal and targeted approach.

In continuing to discuss cross-departmental working within the Council, the Committee asked whether there were any departments with more appetite than others to work on the health inequalities agenda. Nipa Shah highlighted that there was a lot more work to be done on health inequalities and the social determinants that lead to those health inequalities. BHM had made a start on that through the employment of a Link Worker in the team who linked in with Adult Social Care, Housing, and Employment within the Council. Their role was to develop easier pathways so that, when BHM engaged communities, where there were concerns around housing, employment or care needs, there was a clear pathway they could signpost residents to in order to ensure they went to the best place to serve their needs. Tom Shakespeare added that, across the Council, BHM was strongly advocating for departments to look at how services were delivered from an ethnicity, deprivation and disability lens. In doing so, this would shine a light on what further work needed to be done around health inequalities and strengthen that joint working across departments. In addition, Brent Council had adopted a Joint Health and Wellbeing Strategy with priorities that encompassed activities across the whole Council and local NHS system.

The report highlighted the work done with factories in Brent to reach out to employees in relation to their health. Sandhya Thacker introduced Ian Siddons (HR Business Manager, GreenCore) and Nicola Clifton (HR Business Partner, Bakavor) to speak more about the outreach events that had taken place in their factories.

Ian Siddons explained to the Committee that he had started at GreenCore in 2019, where the Covid pandemic shortly followed. At that point, he started working with the BHM team, and had received some help with vaccinations through the vaccination bus coming onsite to ensure staff received awareness on the vaccination. From that initial visit GreenCore had since had two more outreach events, one taking place on the day shift and one on the night shift. GreenCore had approximately 1,200 employees with a very diverse workforce. Many staff lived in HMOs and had caring responsibilities at home, meaning having the health team on site was a big positive for those staff who may find it difficult to get in touch with health services about their own health. Following the two sessions, 239 employees had been assessed on their health, with doctors and nurses onsite breaking down barriers such as language differences due to members of the health team speaking community languages. The sessions had focused on diabetes tests, mental health, BMI tests, ECGs and spoken about diet. The sessions had helped staff become accustomed to people coming in to the workplace to ask them medical questions. The team was able to identify some staff who were at risk of their health and escalated that within the NHS structure to ensure they received treatment.

Nicola Clifton had two similar events at Bakavor on the day shift and late shift. The feedback from employees who had attended the sessions had been exceptionally positive and they had asked for the sessions to happen every 6 months.

The Chair thanked both Ian and Nicola for their presentations and for attending the Committee. He asked if they would suggest something the BHM team could do more of what it would be, with both Ian and Nicola suggesting more health diagnostics with a GP onsite and increasing the frequency of the sessions.

The Chair thanked those present for their contributions and drew the item to a close. He invited the Committee to make recommendations, with the following RESOLVED:

i)              To recommend that cross-council work on health inequalities is strengthened to develop a whole Council approach to further addressing health inequalities.

ii)             To recommend that appropriate Council officers are given training on intersectionality, to further develop the organisation’s understanding of intersectionality and its impact on Brent residents.

iii)           To recommend that neurological conditions within the community are considered for inclusions as part of Brent Health Matter’s work.

iv)           To recommend that healthcare resources are allocated to areas of Brent with greater need and deprivation, so that more targeted work can be done in those areas.

An information request was raised during the discussion, recorded as follows:

i)              For the Community and Wellbeing Scrutiny Committee to receive the latest data on Brent Health Matters’ co-production activity.