During discussion of this item the guillotine fell at 9.00 pm.
RESOLVED: That the meeting continue for a further period of up to 30 minutes.
Councillor Jim Dickson, Cabinet Member for Health and Social Care (job-share), Chair of the Health and Wellbeing Board (HWB), and co-Chair of Lambeth Together Partnership (LTP); Andrew Eyres, Strategic Director for Integrated Health and Care; Ruth Hutt, Director of Public Health; and Bimpe Oki, Public Health Consultant, introduced the item and stated:
· Health inequalities ran through all activities, such as the Delivery Alliance for Neighbourhoods and Young People and mental health; and had been a specific focus over the past decade.
· Varied health outcomes for parts of Lambeth’s communities was indefensible.
· Covid-19 had further exacerbated and highlighted embedded inequalities.
· The recently established Lambeth Together Equality Diversity and Inclusion (EDI) group supported and enabled work across all health and care programmes.
· This report set out the growing understanding of inequalities, particularly for those conditions that most impacted residents such as maternity, hypotension, diabetes, and mental health. In turn, this information was being used to shape the Joint Strategic Needs Assessment and the Health and Wellbeing Board (HWB) Strategy and healthcare priorities.
· Further improvement was needed, but the Government had acknowledged Lambeth’s progress with the new Office for Improvement and Disparities opening in Lambeth, work with Black Thrive, taking the lead on Black Londoner’s health, and on drugs and alcohol.
The Committee next heard from Bell Ribeiro-Addy MP as follows:
· Ethnic minority communities were on average poorer and reported worse local support and treatment from GPs; which compounded stress and consequently their health and wellbeing.
· Black people statistically presented with symptoms of persons 20 years older and were four times more likely to be detained under the Mental Health Act. Black males were 70 times more likely to have serious mental health issues, 60 times more likely to be a mental health facility in-patient, and 40 times more likely to access services via the Police or criminal justice route, than white people.
· The Health Secretary only recently announced plans to remove the discriminatory question on sexual activity for sub-Saharan African blood donations, needed for those with sickle cell.
· Ethnic minorities had higher instances of hypotension, stroke, diabetes, and prostate cancer mortality, which were not genetically based, but resulted from institutional racism.
· Issues in Black maternal health were also prevalent, with mortality during pregnancy and childbirth being four times higher; and increased rates of 121% for stillbirth and 50% for neonatal death. A key problem was that many Black women were not listened to during pregnancy.
· A disproportionately higher number of Black, Asian and minority ethnic males died from Covid-19, which had been highlighted from their likely occupations in key worker roles.
· These issues were longstanding and exacerbated by an unwillingness to acknowledge institutional racism in the healthcare system, and culturally sensitive services and data collection were needed.
The Committee then heard from Livia Whyte, Head of Special Projects and Legacy at Black Thrive:
· Thanks were given to Lambeth Together for the collaborative work undertaken to date.
· Covid-19 had brought health inequalities to the forefront and it was reiterated that black people were disproportionally impacted.
· Improved access, particularly early intervention; and Black-led and culturally appropriate services, were needed to help address the social determinants of health.
· Black Thrive had a programme to support local communities but was on hold due to funding.
· A third of data was missing or inaccurate and this needed resolution to drive improvements.
· The continued disproportionality of poor health outcomes was disturbing and greater co-working across institutions was also needed to address inequalities and improve outcomes.
The Cabinet Member and officers responded to questions as follows:
· The rights of ex-Latin communities in the healthcare system was a crucial issue.
· The 23 March 2022 Lambeth Together Strategic Board (LTSB) had discussed migrant and refugee health. Guys and St Thomas’ Trust (GSTT) had a good health inclusion offer via for new arrivals.
· Lambeth shared resources and worked pan-London on settled communities’ health and care; and had led in translation services during Covid-19, which were also shared between boroughs.
· Lambeth’s community sector networks, and organisations such as Thriving Stockwell and the Portuguese Health and Wellbeing Partnership, linked directly with communities to offer joined-up healthcare. This enabled appropriate communications and responses, improved trust, and detailed what services were available whilst being sensitive to issues such as immigration status.
· Covid-19 work had improved working with communities, building relationships with community leaders, having communities help organise drop-in sessions and engaging via video or WhatsApp.
· Lambeth supported grassroots work by funding community organisations for them to shape offers to meet the needs and challenges of their respective communities, such as emergency food aid or handholding with wider care and support services.
· Lambeth engaged a range of different organisations, including the five key Thriving communities linked to primary care networks (PCNs), to better understand needs and deliver healthcare.
· Dr Di Aitken, GP, Co-Chair of Lambeth Together Strategic Partnership, and Co-Chair the Lambeth Together EDI Group, addressed the Committee as follows:
o The EDI group was formed in response to the pandemic and had begun by reviewing data guided by Public Health England (PHE) recommendations and evidence, and inspired by Black Thrive, to develop a health inequalities dashboard and shared measurement system.
o An assurance report was provided at Board meetings that each of the Delivery Alliances measured selected health inequalities, and these were monitored by the EDI Group.
o NHSE was monitoring core-20 plus five to get NHS organisations to focus on the lowest 20% in the lowest quintile of indexes of deprivation and five-focused clinical areas. Lambeth had also chosen an additional two of diabetes and chronic pain.
o NHSE had included this monitoring into national planning guidance so that all hospital trusts reported performance by indexes of deprivation and ethnicity. Lambeth was committed to reporting similarly and this would also help inform service redesign.
· Rachel Kesse-Addu, GSTT consultant haematologist and sickle cell specialist, next addressed the Committee:
o She and two colleagues looked after 900 adults with sickle cell disease, which largely affected black populations.
o Health inequalities disproportionally affected people of colour and ethnic minority groups.
o Sickle cell was unique and Covid-19 highlighted more issues faced by patients who were considered as clinically extremely vulnerable.
o There was Covid-19 vaccination hesitancy among Black people, but the Unit’s work had seen a 60% vaccination rate which was better than the wider community but was not high enough to protect patients.
o GSTT had one of England’s best-resourced sickle cell units, with better consultant-patient ratios and one of the largest psychology services input, but was not near to desired levels.
o NHSE had redistributed resources to form 10 specialised centres across England with one in both GSTT and King’s College Hospital, to offer comprehensive care to patients across Lambeth Lewisham, Camberwell, Southwark and the wider region.
o There were significant sickle cell challenges, as set out in the All-Party Parliamentary Group (APPG) report, which helped focus NHS Trusts’ on specific achievable aims and it was hoped to improve care for patients.
· It was too early to analyse the Chancellor’s Spring Statement, but the connection between poverty and ill health was correct, and the expected drop in living standards and increasing poverty would drive worse outcomes and needed further review.
· Other London boroughs were adopting Lambeth’s stakeholder co-production model which enabled the Council to trial measures with the community before delivery and learn from its citizens; and was sharing this learning across the capital.
· Lambeth was committed to delivering one big public health event per year but aimed to do more.
· Resident feedback noted appreciation to informally engage with the Council on health matters.
· The Beacon Project offering weekly health-checks in in Angel Town or Kennington, with Beacon Hubs extended to south Lambeth so more community members could engage, which helped build trust and confidence, and supported citizens to use healthcare services.
· The healthcare bus would be utilised for other groups as part of ongoing grassroot projects.
· Other avenues of support were ongoing, such as faith-based delivery and community-shaped projects, such as twice-weekly church and mosque outreach work.
· Evidence was clear that poverty drove poor health outcomes; and it was important to recognise that mitigating poverty would improve health outcomes and bring a fairer society
· The December 2019 Poverty Summit had considered how underlying issues of poor healthcare could be addressed and inequality formed an ongoing theme of Public Health reports.
· Measures to improve poverty included promoting the uptake of the London Living Wage among health care providers and the wider community, supporting people into employment, and increasing educational opportunities. Direct actions included measures such as the distribution of food though the pandemic to tackle food poverty, or the Household Support Fund.
· There would be a range of implications from the recent Treasury Spring Statement, but the Council was committed to working with partners to deliver mitigations to poverty.
· Children’s Services and Councillor Davie were leading on children and family poverty alongside health colleagues.
· Health outcomes and associated determinants remained a core theme across the Council’s and partners’ work.
1. To ensure that migrants are aware of health entitlements and receive the support from local health services that were responsive to their specific needs.
2. To provide statistical data to the Committee on health inequalities, including Healthwatch Lambeth EDI and KPI data, in future reports to evidence progress and collate research to enable the Council and partners to understand Lambeth’s long-term medical conditions, how these affected residents, and mitigations thereof.
3. To provide analysis and mitigations of the impact of rising cost of living on health inequalities.
4. To provide hyper-local positive health interventions, such as HWB buses and professional advice provision, particularly on estates, in discussion with local bodies such as TRAs or local forums, as well as ward councillors.
5. To hold at least two dedicated health and wellbeing events per year for Lambeth’s diverse communities, including for Black, Latin American and LGBTQ+ groups.
6. To promote and improve the showcasing of positive work undertaken with Lambeth’s diverse populations.
7. To embed the All-Party Parliamentary Group (APPG) recommendations across Lambeth’s health services, including black maternal health and cultural competency training.
8. To provide the Committee with research on hesitancy and mitigations to healthcare access.
9. To provide the Committee with more information on the buddying scheme, including aims, outcomes, and future work-strands.
10. To provide statistics on health inequalities in Lambeth with targets for reduction; such as for diabetes, weight, or high blood pressure.