Agenda item

To present the first Brent Health Matters (BHM) Annual Report which summarises the BHM programme approach, achievements between April 2023 and March 2024, and priorities for 2024-25.

Nipa Shah (Programme Director, Brent Health Matters) introduced the Brent Health Matters Annual Report for 2023-24, which was the first annual report of the programme since its launch in 2020. She provided an introduction to Brent Health Matters, which was launched following the first wave of the covid-19 pandemic after the spotlight was shown on the health inequalities that had always existed but been made more apparent during the pandemic. The programme had shown a commitment from all organisations to come together to work with Brent’s communities through an iterative process to continue to understand the barriers faced in accessing and experiencing health and care services. She highlighted that it had been a positive journey in understanding and realising how powerful working with the community could be in informing the work of the system. In presenting the annual report, she highlighted the following key points:

• Attention was drawn to the large variance between different groups of people in terms of their health. For example, there was a difference in life expectancy for women and men in different parts of the borough. Brent was very diverse, with 1 in 3 residents in Brent using a language other than English as their main language, whereas all of the work done in health and social care was conducted in the English language. There was also disparity in long term conditions such as diabetes, cardiovascular disease and mental health depending on ethnicity, where a person lived, employment status and other social determinants.
• BHM was a model and a programme supporting work with Brent communities, accepting that communities were not hard to reach but instead experienced barriers in accessing services. There were various workstreams within BHM working with diverse communities, specifically BAME communities, emerging communities, those experiencing homelessness, people with learning disabilities and mental health conditions, and shift workers.
• The demand for BHM services was growing as the programme became more visible and communities were now trusting BHM more, coming forward and willing to help in co-producing solutions.
• BHM worked with voluntary and local community organisations and to date had worked with around 428 organisations. The aim was to get the voluntary and community sector to a point where they were empowered to find solutions and BHM supported them to do it, which took time.
• BHM was working to co-produce outreach events where health and care services were taken out into the community at a time and place that suited different communities such as faith centres, community centres, factories, high streets, schools and colleges and even a barber’s shop. BHM had also produced assets and messaging in different languages and through various means such as social media, WhatsApp and local celebrities.
• Community grants had helped to empower organisations to support this work and in 2023-24 community grants had been given to 27 organisations to support them to become sustainable. Part of that package included support in monitoring the outcomes of their programmes so that they could apply for larger grants. One organisation that had been supported went on to win the King’s Award.
• The team had engaged with over 5,000 people in Brent in 2023-24. There was also a clinical team provided by CLCH who provided healthcare in the community with 120 outreach events done in 2023-24, such as comprehensive health checks including BMI, blood pressure, diabetes, mental health and atrial fibrillation, with 69% of people seen identified as category 1-4 of the IMD deprivation index. These health checks had resulted in cases being escalated to GPs for further diagnosis and treatment, which would not have been diagnosed otherwise.
• There had been limited success making health inequalities business as usual, as it was now seen as something BHM did. Work over the next year would look to mainstream health inequalities work within partner organisations.
• Moving forward, BHM was working with the Integrated Neighbourhood Teams and the Council’s Change Programme with a strong focus on co-production. BHM had also launched a new team dedicated to children and young people. BHM were also starting to have a presence in Council established places such as Brent Hubs. Work also needed to be done to capture the outcomes of the programme going forward.

The Chair then invited comments and questions from members, with the following issues raised:

• The importance of recruiting staff that reflected the diverse communities BHM was serving was highlighted as this enabled services to build bridges with communities who may not have trusted establishments previously.
• BHM had attended the graduation of the diabetes awareness programme being co-produced with the Gujarati community in Kenton where a group of people had seven sessions over a period of time. Each Monday consisted of a different activity, such as yoga, stretching, food education, and food adaptations, providing education and awareness of diabetes. Speaking to the leader of that community, officers had heard that he was very proud of the scheme and now wanted to open the doors to talk to BHM about dementia and mental health.
• It was acknowledged that the programme was in danger of seeing only the engaged members of communities, or the ‘worried well’, with members querying how BHM was going to capture and monitor outcomes and bring new residents into the work. Officers confirmed that there would be focused work for the following year on both numbers and the communities that BHM saw. Some of that work had been done already, for example, a member of the public health team who was from the Brazilian community had helped with outreach to that group and BHM had been able to learn that one of their biggest concerns was around right to remain and being reported if they attended any health events. As such, BHM had slowly worked with the Brazilian community to build that trust and foster those relationships.
• In response to whether there was linkage with other services of the Council, including Brent Hubs, to give a holistic offer, Robyn Doran highlighted that this tied in with the importance of all mainstream services focusing on the health inequalities work and not just BHM. For her, she reviewed how the rest of CNWL learned from BHM to become more accessible and build bridges with other services for the community such as the Council and CLCH. The focus over the next year would be on that mainstream offer, using BHM as the bridge between services and helping to ensure services were culturally appropriate and sensitive to the needs of the community. The Board agreed that there was a need to look at how the health service was responding to BHM and other initiatives across the ICB in making health inequalities work mainstream, including looking at resource planning, including funding, to ensure prevention reached the maximum number of residents possible.
• Tom Shakespeare (Director – Integrated Care Partnership) highlighted the work being done with Asylum Seekers in hotels as an example of joined up work. Primary care was working hard to get people registered and LNWT were monitoring those coming through without a registered GP and the reasons for that, then putting a plan in place to get those people registered.
• The Board asked whether the information gathered at community health check events was passed on to the relevant GP. Nipa Shah confirmed that was the case, and BHM was lucky to use the same system within CLCH as GPs. GPs could see the information recorded, and BHM could then see whether the GP had seen it and followed up. The team had recently done an audit on the percentage of escalations being followed up. In the previous year the percentage had only been 40-50%, but this year that had improved to 85%. This showed a good improvement but the team would continually ensure escalations were taking place and patients were being linked in with GP services.

As no further issues were raised, the Chair drew the discussion to close, congratulating BHM for the work done so far.