Agenda item

Ben Anderson, Director of Public Health, to present.

The Chair invited Ben Anderson, Director of Public Health to speak to the report.

 

Following on from the 2022 DPH Annual Report on the impact of Covid-19 in Rotherham, this year’s Report considered the wider impacts of the pandemic and some of the longer-term changes in Rotherham from pre[1]pandemic through to March 2023. The report focused on the impact of the pandemic on people, health behaviours, community and neighbourhoods, the environment, and wider socio-economic factors. It looked at the immediate impact of the pandemic during the first wave, how Rotherham adapted to deal with the challenges presented, and the long-term effects on people and the essential services they used.

 

Rotherham is 35th most deprived of the 151 upper-tier local authorities in England. The pandemic highlighted how Rotherham’s deprivation coupled with the unequal distribution of social determinants of health impacted resilience to Covid-19 and the outcomes for the population. These inequalities included exposure to risk factors, education, housing, employment, and led to associated inequalities in physical and mental health. The pandemic exposed these inequalities with people living in the poorest 10% of areas more likely to die from Covid-19, and left sections of society vulnerable to financial insecurity, employment loss, missing education, and unmet mental and physical health needs.

 

The report had been produced using both RMBC service data and community intelligence from Rotherham residents, or those who work in Rotherham. Data was analysed and contextual intelligence gathered through discussion. This information was coupled with significant public engagement.

 

The DPH gave a presentation, highlighting key issues for the Health and Wellbeing Board, including details of the recommendations:

 

Education:

•       Attainment for KS2 indicated there may have been impact following periods of lockdown and home-schooling with a lower percentage of pupils performing as expected in Reading, Writing and Maths in 2022 compared to 2019.

•       Many children, particularly in transition cohorts, were presenting with social and emotional needs, lack of self-regulation, speech and language issues and generally not being school-ready.

•       Since before the pandemic, there had been an increase in year 7 & 10 pupils reporting their mental health as poor, and 35% of this cohort had reported some deterioration in their mental health in the past two years.

•       Some focus group members found workload for children difficult, there were issues with the internet, and some parents, who couldn’t read or write themselves, were unable to support their children with home-schooling.

 

Education - Special Educational Needs and Disabilities (SEND) and Social, Emotional and Mental Health (SEMH)

•       Following the pandemic there has been increases in pupils registered with SEND support needs, and applications for Education, Health and Care Plans (EHCP).

•       More children, and more very young children, were being identified as having social, emotional, and mental health needs.

•       Greater numbers of children were seen to have SEMH needs who did not present with these needs before the pandemic.

•       Difficulties recruiting in the post pandemic labour market for support staff positions and within Special Schools meant there may be a lack of support available for pupils.

 

Primary care

•       151,000 fewer primary care appointments were booked between April 2020 and March 2021 compared to the previous 12 months; the fall in appointment number was most evident in April and May 2020.

•       Despite the number of total appointments decreasing from 2019/20 to 2020/21, the increased number in 2021/22 and 2022/23 had increased by almost double the number that were lost with the decrease indicating a higher level of demand post-pandemic.

•       The reasons for this were not fully understood but may include the impact of lost pro-active care, changes in lifestyle habits during and since the pandemic amongst other factors.

•       Focus group reflections were overwhelmingly negative predominately around the ability to get a GP appointment, and many struggled, and continue to struggle, with this.

 

Secondary care

•       At the start of the covid-19 outbreak, total A&E attendances sharply decreased reaching the lowest value in April 2020.

•       Reductions in visits predate lockdown suggesting that the initial decrease in attendances were as a result of covid-19 awareness, and not lockdown itself.

•       Although we might expect lockdown and subsequent social distancing measures to present reductions in infectious diseases and certain types of injuries, we expect that prevalence of other illnesses, such as long-term conditions, will remain constant. However, concern about infection risk in health and social care workers, may have driven demand for patients to seek care elsewhere.

 

Adult care

Number of adults in care

•       There was a substantial decrease in the total number of people in Residential and Nursing care due to excess mortality at the start of the pandemic.

•       Overall number of contacts for adult care show no overall trend over the course of the pandemic and has remained between 1,500 to 2,200 per month.

 

Integrated discharge team

•       Since the pandemic, there has been an increased number of requests for support from social care to facilitate safe hospital discharge.

•       These included frailty and complex needs demonstrating the rising level of need at this stage in the patient pathway.

 

Transitions

•       Transitions saw scaling back of service visits, and the closure of day services placing an additional strain on carers.

•       Some service used limited contact due to infection risk so had little external contact and reduced socialising with others.

 

Local picture

•       Social isolation and anxiety around catching Covid were reported as the main concerns from service users.

•       Vaccination offered a level of reassurance, but people were still mindful of Covid and continue to take precautions which themselves may be having wider impacts on lifestyles, care access and quality of life.

•       Focus group members reflected on negative feelings around providing care or receiving care during the pandemic.

 

Housing

Income and financial inclusion

•       Tenancy support saw a rise in support calls following the withdrawal of the £20 uplift in UC with tenants finding paying rent more difficult.

•       Longer term, the team have seen financial and emotional struggles among tenants who lost family members due to Covid-19; those who weren’t main earners, those who found themselves under occupying a property having to pay penalties or downsize, and provision for those who needed support maximising their income.

 

Homelessness

•       The service saw a rise in people presenting as homeless with increased vulnerability and multiple support needs e.g., substance abuse and mental health needs

 

Housing advice and assessment

•       Demand for social housing continued to rise since the pandemic ended, although other factors such as cost of living rises were likely to be influencing this.

•       Homelessness and temporary accommodation demand created additional demand in lettings, with more people placed into Band 1 (highest priority for social housing) and extended wait times for people in Band 2 and below

 

Income and employment

•       There was a significant increase in claimant levels in 2020/2021 for Jobseeker's Allowance and those who claim Universal Credit (both in, and out of work).

•       The claimant count has not yet returned to pre-pandemic levels in any area and the post pandemic cost of living crisis and change in economy has resulted in more people in work in poverty.

•       There were significant differences throughout the pandemic between those who were out of work or unable to work due to restrictions in their sectors, and those whose employment continued. Some sectors saw rising demands creating opportunities while others were unable to operate or limited in their operation.

•       Staffing issues impacted education and adult care particularly during the time of the pandemic.

 

Smoking, sexual health, and weight

•       Self-reporting current smokers in Rotherham increased in 2021 to 16.9% of adults.

•       Data indicates that smoking amongst females increased faster than for males in 2021, bringing smoking rates between sexes into parity.

•       The move to digital services and the retention of staff during the pandemic allowed the sexual health service to continue to operate throughout the pandemic in Rotherham.

•       Contraceptive services, specifically LARC, were hampered by a lack of in-person appointments and experienced a decrease in 2020.

•       There was moderate reduction in the percentage of adults classified as overweight or obese in Rotherham in 2020/21.

•       Year 6 (10-11 years) overweight and obesity prevalence has shown an upward trend for several years and was significantly higher than prevalence in reception.

•       Post lockdown, there was an increase in self-referrals for weight management services in early 2022.

 

Substance misuse, alcohol and mental wellbeing

•       There was no large influx of alcohol related presentations during 2020/21 as may have been anticipated and numbers dropped compared to 2019/20.

•       Reduced number, and a smaller proportion, of patients referred by self, family, or friends in 2020/21 compared to previous years.

•       Opiate treatment saw no major changes over the last two years and trends from pre-pandemic continued.

•       Growing numbers in treatment as a result of exits not keeping pace with new presentations.

•       Data for 2020/21 showed a shift towards more patients classified as unemployed or economically inactive presenting for alcohol treatment, which may be explained by changes to the labour market during the pandemic.

•       People have struggled with loneliness, anxiety and other issues with mental health worsening during the pandemic

•       Lasting impacts were still experienced by some people who were afraid to go out of the house and were living with persistent anxiety.

 

Language, communication, and digital

•       Most groups reflected that the guidance and rules were unclear to confirm if they were being adhered to.

•       Amendments were suggested to make the messaging easier to understand in the future.

•       Although there have been benefits to a shift to a digital first approach, barriers still existed for some members of the community that required consideration moving forward.

 

The report outlined a series of recommendation; in summary:

 

1.    That the population health management operational group work to develop further understanding of health and social care demand and service access underpinned by data sharing agreements and mechanisms for reporting.

2.    Areas of concern and post pandemic trends should continue to be monitored.

3.    For future major incidents, that the importance of good communications nationally, regionally, and locally should be recognised by partners.

4.    Recruitment and career pathways within these key sectors that were attractive within the post pandemic economy should be developed by partners.

5.    That people should be supported to regain the confidence to interact normally and achieve full integration with society.

6. That consideration was given to how digital first approaches were rolled out and those excluded by this were considered and able to maintain access.
7. That work to recover services to pre-pandemic positions be monitored and the impact on health inequalities and inequalities considered.
8. That actions to mitigate poverty locally through the provision of poverty friendly services should be considered.

 

It was outlined that the recommendations had been positively received and progress was being made.

 

The Chair invited comments from the Board and the following issues were raised:

•       It was difficult to ascertain if tolerance levels of anti-social behaviour had changed since the pandemic.

•       Primary care had been transformed; however public perception of access to primary care had worsened.

•       There had an increase in numbers experiencing poor mental health.

•       Whilst Rotherham was meeting local targets for operations, there was a backlog sub-regionally and nationally.

•       There was an increase in length of stay in hospitals.

•       Speech and language therapy were experiencing additional demands which were challenging to meet.

 

The Chair invited the Board to submit additional comments to the DPH for consideration.

 

Resolved: That the recommendations (as set out on page 40 of the DPH Report) be agreed.