To consider the attached report.

The Consultant in Public Health gave an overview of the slides that had been circulated with the agenda. The Committee were informed that health inequalities were avoidable and systematic differences in health between different groups of people and the pandemic had exacerbated those inequalities for example, alcohol mortality in Trafford had increased by 50 percent between 2019 and 2020. Health inequalities had been identified as a top priority for the Council, the NHS, and for the wider system.  Social determinants of health drove health inequalities and made it easier or harder for individuals to live a healthy life. Trafford often compared data with other Greater Manchester authorities which could mask issues in Trafford, as the borough had good health outcomes in comparison with GM generally. However, when the differences between equality groups and between affluent and deprived areas within the borough were looked at the level of health inequalities were quite stark.

Slide 11 of the presentation showed the proposed neighbourhood model which was focused upon early intervention and prevention and keeping people healthy within their communities to ensure equitable access to services, so they received the right care in the right place at the right time.  The Health and Wellbeing Board review had reshaped the Board to be focused upon reducing health inequalities. A series of deep dive exercises were planned with system leaders to home in on the key issues and identify work which would have the greatest impact in reducing health inequalities.

The Director of Commissioning for Trafford CCG explained the importance of reducing health inequalities from an NHS perspective. The NHS planning guidance challenged all areas to tackle health inequalities and to show they were reducing inequalities across eight key areas, which would be monitored and benchmarked against other localities. The Director of Commissioning for Trafford CCG highlighted that there was a common thread of reducing health inequalities which ran through all the strategies and work across all health services.  Work was ongoing on the core 20PLUS5, which was designed to support Integrated Care Systems’ by focusing upon the identification of practical solutions to improve outcomes within the 20% most deprived areas of the Country and for those who had poor outcomes within each locality across five key clinical areas.

The Director of Commissioning for Trafford CCG informed the Committee that there was a need to move away from a one-size-fits-all commissioning or transformation approach to one focused upon tackling inequalities.  The approach would require difficult conversations about the allocation of funding to ensure the greatest outcomes from the finite resource available. This, in turn, would rely upon the utilisation of data provided by public health colleagues regarding the wider determinants impacting the health of the population.  The Director of Commissioning for Trafford CCG stated that health professionals had to move away from thinking along the standard medical model to an inequality reduction model. The Director of Commissioning for Trafford CCG added that the transition to the new model of working would create new challenges and it would be important that all partners within the Integrated Care System worked together and supported each other through the transition.

Following the overview councillor Brophy asked whether the areas of deprivation aligned with the key clinical areas of inequality. The Director of Commissioning for Trafford CCG responded that they often overlapped but not always. That was why part of the neighbourhood model involved the development of plans built upon neighbourhood data taken alongside outcome data for targeted patient groups. This would enable a holistic approach to identify key priorities where services could have the greatest impact on health inequalities within each neighbourhood.

Councillor Brophy then asked how resources would be targeted differently to reduce health inequalities. The Director of Commissioning for Trafford CCG responded that targeting services effectively was the challenge and it would require discussion by services and their partners, including the Committee, to get it right. It would require accurate assessment of need using available data and to distribute the resources according to the data.  To achieve the desired effect would also require tackling resourcing difficulties and ensuring Trafford had the right workforce in place with the right pathways to ensure resources were utilised in the fairest way.

Councillor Acton noted that the issues identified within the presentation were the same problems that had been tackled unsuccessfully by other programmes in the past. Councillor Acton then asked why this plan would be more successful than the others.  The Director of Commissioning for Trafford CCG responded that all the changes the NHS was going through brought commissioners and providers closer together, health and social care closer together, and those conditions had not been in place before. The level of accountability within the NHS was also stronger than it had been before. In addition, the increased level of digital connectivity provided better sources of information and meant the NHS were able to interact with the public easier to gather their views which in turn could aid in the development of services. 

Councillor Acton thanked the Director of Commissioning for Trafford CCG for her response. Councillor Acton agreed with the point that there were some good opportunities available but added that he felt there were also greater challenges than before with the difficulties of recovering from the pandemic and the cost-of-living crisis. The Councillor noted that there were only so many elements that the Council and NHS could impact and given the large number of determinants which impacted people in poverty assistance was required from central government to be able to tackle them all.

Councillor Akinola spoke about the high levels of poverty within the North of the borough and how the cost-of-living crisis was likely to see this increase further. Councillor Akinola then asked whether there were any estimates as to what the levels of poverty might rise to and how it would impact the inequalities gap. The Health and Social Care Programme Director responded that Trafford were in a better position than other areas due to the amount of time spent developing the Trafford Poverty Strategy, which had shared ownership across the health and social care system.  The volunteering community strategy was another important development for Trafford in reducing the impacts of the cost-of-living crisis on resident’s health. The Consultant in Public Health added that poverty was the most important determinant of health inequalities.  It was positive that the whole system within Trafford had recognised the impact of poverty on health outcomes and health inequalities and were introducing measures to mitigate the impact the crisis would have on the population. 

Councillor Akinola asked how the level of inequality could be improved when access to services was still so difficult for so many people. The Director of Commissioning for Trafford CCG responded that it was difficult to give a complete answer, but part of the answer was to start to talk to people about why they cannot access services. Once that was known more bespoke services could be developed to address those challenges working with the population rather than having a one-size-fits-all response.

Councillor Mrs Young echoed the comments made by Councillors Acton and Akinola that it had been known for a long time where the pockets of inequalities were in Trafford. The problem was that when you brought in services to tackle the issues of those areas only a limited amount of the help got to those who truly needed it.  Councillor Young then asked whether it was possible to have a system whereby you could provide support only to the people who needed it. The Director of Commissioning for Trafford CCG responded that the targeted service Councillor Young envisioned was the ambition of the service with the resources and support going where they were needed the most. However, the service had to ensure that they did not inadvertently disadvantage other areas in the process.

Councillor Hartley asked how the Committee were to assess whether the service had been successful or not in reducing health inequalities. The Consultant in Public Health responded that the data shown in the presentation was one way success could be measured but it would take a long time for the impact of the work to be visible. However, there were a number of intermediate and proxy measures which captured quick improvements such as the uptake of health checks for people with a serious mental illness or improved cancer screening in the neighbourhoods where the uptake was low. Those indicators were included within the corporate plan for health inequalities and there were other indicators associated with the planning guidance as well, so there were a few ways that the Committee could assess whether progress was being made.

Councillor Taylor noted that data gathering was key to identifying problems and asked whether the officers could expand on the nature of the data and how they would gather accurate data about transient populations such as Clifford ward. The Health and Social Care Programme Director responded that both qualitative and quantitative data was to be collected to enable the making of the difficult decisions on what needed to be done with regards to service transformation. The Committee were informed of the approach that was being taken to data gathering, but the Health and Social Care Programme Director recognised that a forum was needed which could bring the public voice to the fore and influence decision-making. 

Councillor Taylor then asked how counsellors could help with that process. The Health and Social Care Programme Director responded that Councillor involvement would be greatly welcomed as they would bring a completely different dimension to the discussions. The Consultant in Public Health added that elected member involvement was wanted for the neighbourhood plans and would welcome the involvement of the committee. The Consultant in public health then described the consultation work that was running alongside the development of the neighbourhood model to capture the patient voice.

Councillor Brophy noted the strong VCSE sector within Trafford and that there were more of those organisations in the South than the North of the borough. Councillor Brophy then asked whether there was any scope for twinning areas of the borough with high levels of VCSE support available with areas which had lower levels of support to offer a more consistent level of support across the borough. The Health and Social Care Programme Director responded that he thought it was a really good idea and he recognised that Trafford had to think differently about how to deliver services to make the most of the resources available. The Health and Social Care Programme Director informed the Committee of work that had been done on the new volunteering community and faith and social enterprise sector infrastructure contracts, which had co-produced what the contracts would look like. It was hoped that when the contracts came into effect in October there would be opportunity to shape the support from the sector and to look at ideas like the one Councillor Brophy put forward.

The Corporate Director of Adult services spoke of the challenges Trafford faced which had culminated in a “perfect storm” that was going to hit Trafford residents very hard. The Corporate Director of Adult services stated that the Committee were right to be concerned and to hold services to account. The point Members had raised about previous unsuccessful attempts to impact health inequalities showed a different approach was required, which was why a lot of Trafford’s funding was going towards a targeted piece of work to reduce health inequalities produced as part of the Health and Wellbeing Board review with support from the Local Government Association.  The Corporate Director of Adult services asked Members to keep challenging nationally and locally to ensure Trafford received adequate funding to support the prevention activity within the borough.

Councillor Gilbert asked what the government targets for the 20PLUS5 were and when progress against those targets could be brought to the Committee. The Director of Commissioning for Trafford CCG responded that there was a need to look at the information on GP systems to identify people at risk and the ICS had to submit where they were up to across the five areas in October, so information could be brought to the Committee after that point.   

Councillor Lloyd asked whether some of the data from previous initiatives could be used to achieve quick wins.  The Director of Commissioning for Trafford CCG responded that through data gathered previously the service did know it was areas like Partington and pockets in areas like Hale Barns where health inequalities were the worst. The work now was to understand the inequalities people faced and what was driving those inequalities. Once that was known Trafford was in a position, with the Locality Board in place, to tackle those problems collaboratively to bring about change and reduce health inequalities.

The Chair of Healthwatch Trafford stated that to help people through the cost-of-living crisis Trafford could make sure people claimed all the benefits that they were entitled to. Another area that could help was tackling digital exclusion among the population and to enable people to access the internet.

The Chair concluded the item by recognising the excellent contributions that had been made and stating that while there were a lot of challenges facing Trafford residents there was a strong resolve across the council and their partners to make a positive difference.

RESOLVED: That the presentation be noted.