Agenda item

To provide a presentation highlighting Brent’s work to tackle inequalities, including key data on inequalities within Brent and compared to reginal and national data, best practice in tackling inequalities, and using best practice and local insight to further develop the approach to tackling health inequalities within Brent.

Ruth du Plessis (Director of Public Health and Leisure, Brent Council) and Dr Rammya Mathew (Vice Chair of Brent Health and Wellbeing Board) led a presentation on inequalities in Brent, highlighting what inequalities were in terms of key data and national and regional comparators, best practice for tackling inequalities.  Also how local insights and data had been used to further develop the approach to tackling health inequalities in Brent, and how Brent continued to refine efforts towards tackling inequalities. They highlighted the following key points:

·       The recently published Indices of Multiple Deprivation (IMD) 2025 was used to indicate Brent’s position in terms of inequalities across the 296 local authority areas. Brent was ranked 41^st most deprived area in England and 12^th highest for income deprivation. Within London, Brent remained the 4^th most deprived borough since the last IMD in 2019. Data showed clear gaps in life expectancy at birth between the most deprived and least deprived areas in Brent, and a gender gap with males living an average of 6 years less than females in Brent.

·       Brent was focused on tackling inequalities through a prevention lens, based on population health data and the wider determinants of health, using evidence-based interventions that were tailored to local need. In order to do this, health services were being asked to design services based on the wider determinants of health, using neighbourhood health as an opportunity to tackle inequalities as core business.

·       Workstream one was for all partners to take a ‘no wrong door’ approach, taking a joined-up, system-wide approach to supporting vulnerable residents and identifying those who may need additional support.

·       Workstream two focused on community connectedness, building trust, capability and connection with Brent’s diverse communities, including through aligning community-based roles such as social prescribers, community connectors and health educators, and embedding VCSE partners, into the inequalities programme. This workstream would also review community grants to ensure alignment with resident-identified needs and population health priorities.

·       Population health management was the third workstream, using data and insight to target resources where they were most needed, applying proportionate universalism (universal services for all with more intensive support for communities with greatest need) and aiming to reach residents with unmet needs.

The Chair thanked colleagues for their presentation and invited contributions from those present. The following points were made:

·       The Chair highlighted the importance of learning from this work in order to inform public services across Brent and future plan in relation to inequalities and neighbourhoods. He noted that working together in neighbourhoods and the Brent Health Matters Annual Report were also due to be discussed during the meeting, which all linked with the work being done to understand and address inequalities in Brent.

·       Councillor Donnelly-Jackson advised that she was pleased that the Council had adopted the Socio-economic Duty, ensuring that socio-economic status was considered as a protected characteristic, and encouraged other partners to do the same.

·       Noting the references in the presentation to unmet need, the Board asked for further clarity on what was meant by that. Dr Rammya Mathew explained that this referred to large and varied needs. As a GP, she saw patients coming to her attention very late in their condition with multiple chronic unmanaged conditions, which was often linked to the fact they found it difficult to access services, including screening and vaccination offers. Low uptake of screening and immunisations was found to be more common in deprived communities.

·       Resource allocation was raised, with it noted that this had historically not been done proportionately across North West London and London as a whole, with outer boroughs traditionally receiving less resource, particularly around community and mental health services, and Brent not receiving an allocation that recognised it was one of the most deprived of the 8 NWL boroughs. This was an issue that Brent Integrated Care Partnership (ICP) had raised consistently, highlighting an aim to develop and put more money into services to level Brent up, and the ICP would continue to raise that as the 8 boroughs merged with North Central London in April 2026 to become a 13 borough Integrated Care System (ICS).

·       Within the new North West and North Central ICS, 4 pillars of proactive care had been set out, including creating community assets for health and wellbeing, early identification and early help. Over the last few years, particularly in children’s services, Brent had started seeing new money, but this was still not the case for community services, so members felt it was important to continue to raise this and for partners to understand the population and levels of deprivation in the borough. Brent was also addressing the lack of resource through neighbourhood health, piloting approaches in areas such as Harlesden where there were more pressures and more deprivation. Members could foresee the positives of a neighbourhood health approach in this regard, where the model would depend on the individual need of neighbourhoods and could be flexible based on that.

·       In relation to lack of access to health services for those in higher areas of deprivation, the Board asked what the factors leading to this were, and whether this was because there was a less equal spread of services across those areas or because families were not making use of the services. Ruth du Plessis advised that there were a number of factors affecting access, such as the system not yet having got it right in terms of putting resource where it was needed, the lack of resource in more deprived communities, and evidence suggesting that some families did not have the confidence to access services even where resources were available. Shirley Parks added that some of that was being addressed at Family Wellbeing Centres (FWCs), where referrals and signposting helped vulnerable families navigate the health system, recognising that it was a complex system, particularly for those whose first language was not English, in order to understand what was available to them. FWCs also hosted some health services within the centres to make it more accessible to families to access services in one place. In addition, the Brent Health Matters Health Inequalities Children’s Programme had specific resource to address access for hard-to-reach communities and was looking to make a bid for further funding to resource people whose active role was to help connect families with services and help them understand the benefits of the services available to them. Schools also played a big role in helping families understand what services were available to them.

In concluding the discussion, the Chair encouraged partners to consider adopting the Socio-Economic Duty in the same way the local authority had done. He highlighted the opportunities with the new ICS for the Health and Wellbeing Board to communicate directly with the Integrated Care Board (ICB) around resource allocation and neighbourhood working. He recommended that he, as Chair, and Dr Rammya Mathew, as Vice Chair, wrote to the incoming ICB on the points raised during the discussion on behalf of the Health and Wellbeing Board.