Agenda item

To consider a report exploring the progress made 10 years on from the Marmot review in respect of addressing health inequalities.

Consideration was given to a report providing an overview of progress over the last 10 years related to the Marmot Report, which revealed significant health inequalities throughout the country. The report illustrated that very little positive progress, if any, had been made over the last 10 years in respect of the six objectives outlined by Marmot. These were: giving every child the best start in life; enabling all children, young people and adults to maximize their capabilities and have control over their lives; creating fair employment and good work for all; ensuring a healthy standard of living for all; creating and developing sustainable places and communities; and finally, strengthening the role and impact of ill-health prevention. With respect to these goals, findings had shown even greater decline and deprivation in people’s health broadly in the last 10 years. The report averred that initiatives from central government emphasising changes to behaviour of individuals and to the health care system had not been hugely effective, indicating the serious need to identify and shape the social determinants of health. The challenge, then, was to find ways to improve the social determinants of health without the benefit of extra local government funding following a decade of austerity. It was noted that the purpose of bringing this report today was to garner input that would feed directly into the consideration and decision on this topic by the Health and Wellbeing Board at its 16of September meeting. Data illustrating how deprivation has affected Rotherham, specifically, was also considered. The data included Rotherham’s measure on the indices of deprivation, covid-19, and other areas related to health inequality and social determinants of health. It was noted that on some measures Rotherham has not followed national trends—with worse outcomes for women than for men.

In discussion, Members requested more information to explain why this area had declined so much in the last 10 years, and if anything could be learned from other areas that have not declined as much as Rotherham. In response, officers emphasised the difference in baseline status of the various areas and authorities. A further response in writing was offered in order to provide more detail from a Public Health perspective as to lessons learned comparatively with other areas.

Clarification was also requested regarding the provision of testing to people with disabilities. In response, officers provided reassurances that people with disabilities had been involved in testing, and it was agreed that one of the officers would come and talk to a meeting of Speak Up to answer more questions about this topic.

Members asked if more funding would be provided to help refresh efforts in early intervention and education. The answer asserted that no extra funding from central government could be expected. It was noted that places where there were lots of tests and positive cases were not the only areas of concern because places where there have been none or very few could hide another issue. Currently, there was a recruitment campaign for a community engagement team, using the temporary infection control fund money. This team would work closely with neighbourhoods teams, housing officer teams and social care teams to speak to people in an effort to understand the challenges people are facing as we move forward. We are trying to monitor to understand what is bringing people through our doors who have never before come to us prior to the pandemic. Their situations may not trigger social care, but these investigations give us information as to what early intervention response is needed, which includes a concerted place response as well as a Council response. One thing that the Community team will be doing is a tracing wellbeing interview, to support people who have COVID and attempt to understand the spread as well.

It was asked whether there were other areas of the country with lesser rates of decline that might have some strategy or practical approach to offer Rotherham. Members further inquired as to whether face-to-face doctor’s appointments could be expected to return, as many Borough residents were hoping. In response, it was noted that face to face GP appointments would likely be a rarity for the foreseeable future, and that it was up to the individual practice to determine how and when the office would resume face to face appointments. In response to the first inquiry, The Cabinet member noted the exemplary work of another local authority in response to Marmot which had been included in the agenda pack. It was further noted that all the chairs from the Health and Wellbeing Boards throughout the Region met on a regular basis to share good practice. Officers also emphasised that it was very much not the case that Rotherham had not done well at something that others are excelling at—this was a nationwide problem. Officers also provided assurances that communities-of-interest meetings are convened regularly with colleagues across Yorkshire and the Humber to share best practice, and that any best practice is carefully considered as to how it might be usefully made applicable to Rotherham. It was noted by way of example that rural areas have had lower infection rates than urbanised areas or areas in which many people commute to other urban areas for work. It was further noted that Rotherham was currently in the lowest category for infection rates, and that improvements in this area were something to be proud of.

Members observed that, while Rotherham has a legacy of health conditions caused by work in heavy industry, it was advisable to invest in the health, safety and education of Rotherham’s youngest citizens for best long-term health returns. It was noted that the key was to postpone accumulated conditions for as long as possible. In response, it was agreed that a wrap-around approach was best for supporting health throughout a person’s young years and beyond, not just care at the very beginning of life. It was emphasised that efforts were undertaken to ensure that enough support was provided so that those who have acquired conditions later in life could remain independent as long as possible. These solutions having to do with social determinants were lifelong and were not quick fixes, nor would the effect be short-term.

Members also wished to learn more about possible policies or strategies that might be effective at mitigating the poverty in the Borough that often causes health inequalities. The goal was to eliminate the poverty and deprivation, which would automatically reduce many kinds of health inequalities. In response, the Cabinet member noted the 10 years of austerity and legacy of general underinvestment in the North. It was agreed that efforts in this direction have been emphasised in the Health and Wellbeing Board in recent years, upon realising the need to shape the wider determinants of health. It was further noted that recently, colleagues in Leisure and Culture have been invited to participate in these discussions and that multiple directorates and partners might be involved in developing policies that support Rotherham’s development into a place with low unemployment and less deprivation. Officers provided assurances that housing and green spaces are emphasised in cross-directorate conversations.

Members further agreed that much good work has been done by the Council, and it was suggested that greater documentation and publicity of the Council’s efforts to mitigate poverty be carried out, for example through adding an assessment to Council Reports to show that the effects on poverty and deprivation were considered as a priority in all areas of business. It was the desire of the Health and Wellbeing Board to work with other directorates and partners to help develop a healthier culture. It was noted that the impact of COVID and mental health would be a topic of upcoming work. It was further noted that the comment about documenting the Council’s work on mitigating poverty would be raised with the Council’s Strategic Leadership Team.

Members inquired whether funds were or could be directed for use in areas of greatest deprivation, and it was asked whether strategies for the short, medium and long term might be developed to stop the negative direction of travel and to turn things around with respect to health inequalities. It was noted that in a time in which there are limited funds, directing funds to areas of greatest deprivation made a lot of sense. Officers noted that this was a strategy that was undertaken already for example by the neighbourhoods teams and the Rotherham Partnership, among others.

Members inquired about how culture and the arts are being used to make more people healthier. Officers provided assurances that the Culture Sport and Tourism team had been working in green spaces to create local opportunities to enhance wellbeing such as through a commemorative garden to memorialise loved ones. It was noted that this was a big piece of work and a future update to the Health Select might be important. It was noted that social and cultural activities played a part in mental health and contributed to the five ways to wellbeing. A specific upcoming opportunity was cited as an example: weekend activities involving an art installation at Clifton Park. Councillors had also been using their designated ward funds to plant flowers and to install basic play equipment in some of the parks. It was stated that all of these efforts helped.

Members requested assurances that the plan that was being developed might avoid being based solely on individual responsibility, since such approaches had been largely ineffective over the past 10 years. In response, officers noted that targeted work on breastfeeding and immunisations would be included in the Partner Plan. The Health and Wellbeing Board will also be working with Children and Young People’s Services.

Members asked for further information about the role of the JSNA in the refreshed approach to the Marmot objectives. Assurances were provided that the data would be consulted in the decision-making and would be used to map progress toward improvements as well. Further clarification was provided that the JSNA is indeed a public document that anyone can access. If not, please contact officers for assistance in viewing the Ward data.

How does “Making Every Contact Count” feed into improving the wider social determinants of health? Officers provided the example of housing officers working to ensure that MECC became a part of day to day business communications. The feedback from Housing was that MECC had made a fundamental difference in how housing officers interacted with people, and to help find out how residents felt and how they were using green spaces. This was a way of having those community conversations, and it helped people engage with communities and with housing hubs, and as a way of conversation it helped people examine their own motivations for themselves. Officers also supplied the recent example from a COVID perspective that by being able to contact people directly through the Community Hub volunteers and officers were able to do wellbeing checks that the NHS could not really do, so this allowed people to be helped and supported in a broader context than would be otherwise possible.

Recommendations:-

1.       That partner organisations and officers of the Council in areas such as Communications and in Culture, Sport and Tourism be consulted in the development of alternative strategies for public engagement to promote health through arts and cultural initiatives.

2.       That the Health and Wellbeing Board identify and consider environmental implications that uniquely affect post-industrial areas of Rotherham as well as policy implications, such as selective licensing and social inclusion policies, which may affect health and wellbeing of Borough residents.

3.       That mitigating poverty be an ongoing priority in the short and long term of all plans and strategies of the Council as appropriate, and the efforts to mitigate poverty be documented and publicised.

4.       That the Health and Wellbeing Board develop plans and identify actions to address declining health outcomes for women.