Improving health and tackling inequalities

Improving population health

Improving the health of the people in West Yorkshire involves both taking action on factors affecting physical and mental health alongside overall wellbeing such as healthier communities. A population health approach also involves a focus on reducing inequalities – taking action to understand and reduce gaps in health between different population groups.

To make the changes we need to improve the health of the population we need to work in partnership with health and care services, communities, and partner organisations. Delivering an effective population health approach takes coordinated system efforts on:

• factors driving healthy conditions – the core determinants of health
• the things we can do to support healthy lifestyle behaviours and support early diagnosis – prevention
• and taking action to reduce the gaps we see in population health – reducing health inequalities

Core determinants of health

We know that around 80% of the things that generate and sustain good health, are things outside of healthcare. As well as individual factors, social determinants have a strong influence on the health of the population. This includes the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

West Yorkshire’s leaders have come together recognising the value of collaborative, partnership working around inclusivity and health determinants. There has been a commitment to work together on these issues and jointly resource a small team to catalyse system change. There is strong base and potential to grow the national recognition for the leadership role that West Yorkshire plays in this area of work.

Mitigating against the structural obstacles to good health through civic action is a key to reducing health inequalities. This includes use of legislation, regulation, taxation, and licensing within devolved local powers to help make healthy choices easier for people. Local government focus on improving this level of intervention needs to be targeted appropriately to reach all relevant parts of the population.

It is clear, therefore, that the contribution of combined authorities, and local authorities are hugely influential in the health of the population, and any powers and resources that are within the control of these institutions should be looking at ways of positively maximising their impact on the population’s health. Broadly, this work will be driven by working on three main ways:

• health and inclusivity in all policies
• programme delivery
• development of future ambition for the region

Area of focus: The cost-of-living crisis

The cost-of-living crisis facing our country and region is more than an economic issue. It will have far reaching implications for health and care services across West Yorkshire and will impact across both the people we serve and the staff we employ. We know that financial hardship directly impacts on the mental and physical wellbeing of people, and as more people are pushed into poverty this will increase the number of people who need our support. We also know that a significant proportion of employees in our organisations, as well as carers and volunteers will also be directly affected. This is a priority for us all, and all partner organisations across West Yorkshire are taking action to support people during this time.

The actions are available in more detail here however, the collective actions we have agreed collectively with the West Yorkshire Combined Authority (WYCA) are focused on:

• reducing costs to households and providing support to employees in financial hardship
• investing in voluntary and community sector organisations
• ensuring mental health and suicide prevention services are providing the appropriate support
• ensuring that services are proactively responding to the impact of the cost-of- living crisis

The oversight of joint work is managed through the Improving Population Health Function at ICB level, supported by a steering group comprising of the ICB, WYCA, Local Authorities and VCSE partners. The Combined Authority is also taking action by supporting businesses with funding for energy efficiency measures, and reducing the cost of travel by bus, in addition to implementing the Mayor’s Cost of Living Fund.

Housing and healthy places

We know that having a warm safe place to call home is one of the greatest determinants of health and wellbeing and in WY we have worked together to build on housing and health initiatives. The impact on health and wellbeing is determined both by the physical nature of our homes and also the emotional and psychological impact of how secure and happy we feel with our living situation.

Our Housing and Health partnership has worked to facilitate sharing of good practice across the five West Yorkshire places. Core objectives for our housing and health partnership are:

• embedding health as a consideration in all WY housing plans and interventions.
• promoting and supporting the housing and built environment needs of specific groups: ageing well and dementia.
• promoting and supporting the housing and built environment needs of specific groups: people with multiple vulnerabilities.
• improving the quality of existing housing stock within the region and reduce health inequalities due to poor living conditions and the built environment.

Economic growth and innovation

As part of our work to deliver the strategy we will be working closely with the WYCA to embed health and health inequalities as a consideration for any growing business or start-up. We will also seek to promote local procurement practices within the anchor institutions of each local area, including healthcare organisations.

As described earlier in this plan we will work to address poverty and the cost-of-living across the region with a co-ordinated approach involved in public sector, third sector and the Leeds City Region Economic Partnership and local businesses. We will also seek to promote and enable healthtech development and testing within all areas of WY, including academia.

Employment and skills

Employment and skills are an important element of people having a sense of purpose and something meaningful to do whether that be paid of unpaid employment. We will work with the WYCA to:

• take a public health approach to reducing unemployment: people with long- term health conditions
• take a public health approach to reducing unemployment: school leavers and long-term unemployed
• use the power of regional healthcare organisations to promote caring and healthcare support careers for local people
• promote fair work across the region
• strengthen and grow volunteering pathways into employment across the Partnership.

Transport

Transport is an important contributor to good health and wellbeing, through ensuring the ability to access health appointments and treatment, access good employment and to make the social connections needed. Our work with WYCA will look to develop sustainable routes of transport to healthcare organisations across the region and to consider the impact on health of all future transport infrastructure and planning. We will also work to promote sustainable transport and travel programmes for culture and social value and to promote sustainable travel where appropriate.

Meeting the climate change challenge in everything we do

Climate change has rightly become an increasingly important feature in our everyday lives. We are all affected by it and, health and social care contribute significantly towards causing it. Climate affects all the determinants of health and wellbeing in our communities.

Dealing with climate change requires everyone working and volunteering in health and social care in West Yorkshire to act to reduce our environmental impact, but also to prepare for the changes that are already taking place and that will intensify in future.

Focusing on climate change is challenging in a system which is already overstretched and under significant pressure. However, failure to address our societal and environmental responsibilities will lead to increasingly frequent and severe emergencies.

Delivering the West Yorkshire Climate Change Strategy

Our Climate Change Strategy aligns to our Integrated Care Strategy and sets out system ambitions on climate and sustainability, establishing our economic model of managing trade-offs, and highlighting that we need a risk management approach.

Climate change is fundamentally a human health issue because the drivers of climate change are also the drivers of ill health and health inequalities. We cannot be healthy if our biosphere is poisoned. In providing health and social care, we are contributing to the degradation of the environment on which we all depend by:

• burning fossil fuels for heat and transport
• using single-use plastic
• eating unsustainable food
• taking too long to adopt digital technologies
• underestimating our influence on the supply chain
• undervaluing water supplies
• being profligate with our medicines
• accepting unwarranted variations in care
• underrating the health benefits of our green and blue spaces.

Here in West Yorkshire, we have an ambitious Integrated Care Strategy which is helping us to reduce inequalities in our communities as well as weaving climate action into all we do. Our Partnership has an agreed vision for the future of health, care, and wellbeing in West Yorkshire, where all partners are working together so that people can thrive in a healthy, equitable, safe, trauma informed, and sustainable society.

Our Integrated Care Strategy sets out an ambition for this area that "We aspire to be a leader in the delivery of environmentally sustainable health and social care through increased investment, mitigation, and culture change throughout our system”

In a future where we fail to act, we will fail to achieve our ambitions and vision. Instead, we will see more morbidity, mortality, and inequality, and the system will struggle to cope, eventually failing under impossible demand. We can expect:

• more people suffering with cardiac disease
• more people developing and dying of respiratory conditions
• more people in food poverty and facing foodborne illness
• travel and transport difficulties for patients, residents, and staff
• increased malaria and other vector-borne diseases
• disrupted supply chains with essential supplies increasingly unavailable
• new and emerging communicable diseases
• significantly increased inward migration to the region from other parts of the UK facing extreme weather and flooding
• community collapse leading to poorer population mental health, trauma, violent crime, and possibly increased suicide rates.

But that future is not pre-determined. In a future where we get this right, we can see better outcomes through better models of care, including:

• more people helped to stay in better health and remain independent
• care closer to home
• digital appointments as standard
• comfortable, efficient, and well-insulated homes safe from extreme temperatures
• health and care staff who travel actively on flood-resilient green and blue routes, with local public sector anchor organisations leading the way in their adoption of active travel
• cleaner air leading to fewer respiratory, cardiac, and neurodegenerative conditions
• good-quality housing, and employment in a sustainable, fair local economy
• a regenerative, local food system that ensures all people can afford a good diet
• places and system designed to minimise, and prepare for, new infectious diseases
• green social prescribing and access to green spaces.

This will not be achieved by the work of individuals in isolation. We must act together so that the sum of our improvements is much more than each one of us, or each organisation could do on our own.

NHS Green plan

Big organisations such as NHS Trusts have big footprints because of their estates and fleets and because of the nature of their work.

Rightly, they are the first focus of the national Greener NHS team and there are some statutory climate obligations for them to deliver. These are laid out in our Partnership and Trust Green Plans. Local authorities are also doing a lot of good work, some to meet their statutory responsibilities and some are going beyond, of their own initiative. This work is not sufficiently joined up across the different parts of our system so we will create and enhance these relationships, because interconnected challenges need interconnected solutions.

By being agile, smaller organisations have an important role to play. They can make changes quickly and then advise their bigger partners on successes. By distributing, expertise and funding, smaller organisations can contribute, benefit, and thrive, even if some initiatives fail.

Prevention

We will continue to focus our efforts on prevention across the life course ensuring we work together to; reduce risk factors for ill health, diagnose conditions at an early stage and supporting self-management of long-term conditions. Our focus on Primary At all of these points on the prevention pathway we will focus on how we can target our resources and approaches to ensure we reach those who are in greatest need. This targeted prevention approach will help us to meet our partnership ambitions to reduce inequalities in life expectancy and years of life lived in good health.

Primary prevention: reducing behaviours that lead to poor health

As part of the NHS Long Term Plan, we are required to deliver specific actions to support people to quit smoking, to reduce the impact of alcohol on health, to reduce obesity prevalence and to increase the proportion of people living with a healthy weight.

In addition to national requirements, we work across our system to expand our approach to primary prevention to influence a shift in resources for a health and care system that has a more equitable focus on prevention and not just treatment of ill health. For example, we have a significant workstream in partnership with West Yorkshire Violence Reduction Unit (VRU) focused on preventing and reducing serious violence. We continue to implement all the prevention asks of the NHS Long- Term Plan, working with all Trusts and integrated partnerships at place to provide support and oversight.

Safeguarding our population

Safeguarding is a shared responsibility across the health and social care economy. Our safeguarding teams work with colleagues from across the NHS, Local Authorities, West Yorkshire Police, Statutory and Non-Statutory Partnership Boards, and other partner agencies to drive improvements through local and regional partnership working to embed responsive safeguarding practice. This enables us to address national and local priorities and influence safe and effective care and commissioning. Effective safeguarding at both system and organisational levels relies on systems that ensure safeguarding is integral to daily business.

The delivery of safeguarding duties for children and adults is one of the ICB’s statutory duties, this means we will ensure oversight and assurance of the delivery of the NHS safeguarding accountability and assurance framework via the ICB’s Safeguarding Oversight and Assurance Partnership.

We will continue to ensure that we have effective all age safeguarding arrangements which seek to prevent and protect individuals from harm or abuse and that the principles and duties of safeguarding children and adults are holistically, consistently, and conscientiously applied in everything we do.

Serious violence duty

Integrated Care Boards are one of the five duty holders and as such are required to work together to specified to prevent and reduce serious violence. We will continue to use our established partnership with West Yorkshire (VRU) to response to the requirements of this duty, building on existing work with the aim of further reducing incidents of serious violence.

Primary prevention objectives:

• Tobacco: We will implement pathways for treating tobacco dependence (as a complement not a substitute for local authority’s own responsibility to fund smoking cessation) for:
  • all hospital patients who smoke (including mental health)
  • all pregnant women who smoke and their partners building on our West Yorkshire Mums Can campaign which targets young pregnant women who smoke.
  • those with long-term mental health conditions who smoke and those who are in learning disability services.
• Alcohol care teams
  • we will continue to support Bradford Teaching Hospitals NHS Foundation Trust and Mid Yorkshire NHS Trust to implement their plans for alcohol care teams.
  • we will share the learning from the delivery of these programmes to support further roll out across the partnership.
• Weight management and living with obesity
  • We will provide access to NHS Digital Weight Management Programme. This will include targeted and tailored approaches through primary care by ethnicity and deprivation quintile.
  • We will coproduce a strategy for West Yorkshire that includes our vision and principles/ways of working to support a compassionate, trauma informed life course approach to weight management and living well with obesity.
  • We will work as a system to understand and respond to existing and new treatments to ensure equitable access and ongoing support for obesity management.
• Violence reduction
  • We will continue work in partnership with the West Yorkshire Violence Reduction Unit to provide a population health approach to reducing serious violence and supporting the sustainability of the unit.
  • We will identify and implement interventions to prevent serious violence (including violence against staff) across health and care setting.
  • We will work across the partnership to support the coproduction of a Serious Violence Needs Assessment and Response Strategy.
• Domestic and sexual violence
  • We will continue to work in partnership with colleagues across West Yorkshire to ensure that we build upon the current work being undertaken around domestic abuse and the impact on children and adults.
  • We will work with NHS England’s Domestic Abuse and Sexual Violence (DASV) Programme to build on our robust safeguarding processes for protecting patients, improve victim support, and focus on early intervention and prevention.
  • We will enhance our response to domestic abuse and sexual violence associated with NHS Services whether experienced by patients, staff, or visitors.
  • We will adopt a systematic zero-tolerance approach to tackle domestic and sexual violence against staff and patients which encompasses prevention and support.
  • We will aim to build a network to ensure the sharing of good practice, identify issues and develop solutions to tackling domestic and sexual violence.
  • We will ensure that all staff have access to an ICB Domestic Violence and Abuse Policy so that both victims and perpetrators of domestic abuse are aware of the support that is available to them within the organisation. This will also provide guidance to line managers when supporting staff who are affected by domestic abuse.

Health inequalities

The strategic health inequality ambitions for the West Yorkshire ICB overlay with national requirements of CORE20Plus5 in relation population groups and clinical areas of focus.

We know that we have over 20% of our population live in the most deprived 10% nationally and that delays caused by the pandemic and increasing fuel and food poverty in our places is likely to have worsened.

We will continue to target our approach to reducing health inequalities based on local intelligence of population need and focussing our efforts where collective action is required across West Yorkshire.

There is an 8.9 year gap for males and an 8 year gap for females in average life expectancy between people living in communities ranked in the most deprived 20% compared to the least deprived 20%.

Population intelligence for West Yorkshire has shown us the causes of death that contribute most towards the gap in premature mortality by deprivation for West Yorkshire are: Cardio vascular disease, respiratory disease, and cancer (specifically lung cancer).

Our collective West Yorkshire approach to reducing inequalities will focus on three specific areas;

1. Accelerating targeted preventative programmes – aligned to the clinical domains of CORE20Plus5 and the incoming NHS England Major Conditions Strategy. There will be a focus on reducing inequalities in access and experience and to improve outcomes.
2. Increasing partnership capability to reduce health inequalities through our Health Inequalities Academy. The aim of the academy is to spark curiosity and to equip people with the skills required to understand and address inequalities from their specific role within the system. We have established multiple different channels for learning and development including: online learning resources, a Population Health Fellowship programme, and bespoke communities of practice.
3. Development and delivery of a West Yorkshire Inclusion Health Unit. To provide dedicated capacity to understand the needs of the communities that experience the greatest health inequalities and deliver services that better meet their needs. Addressing inequalities for inclusion health groups requires a different approach and benefits from work at scale for collective action for those populations that are small in absolute number but great in need. One of the key areas of delivery of the unit will be the Partnership of Sanctuary - embedding approaches to improve the health of refugees and asylum seekers across West Yorkshire.

Health inequalities objectives

• Inclusion health
  • We will implement a West Yorkshire Inclusion Health Unit in partnership with local VCSE organisations.
  • We will continue to maintain our status as a Partnership of Sanctuary through the delivery of a cross-system action plan.
  • We will continue to implement CORE20Plus5 Community Connector projects and share learning across the system. This programme focusses on two distinct population groups that see some of the greatest health inequalities in West Yorkshire – Refugees and Asylum Seekers and Gypsy and Traveler populations
• Leadership capability
  • We will continue deliver the West Yorkshire Population Health Fellowship with the delivery of projects on health inequalities, trauma, and climate change.
  • We will continue to develop and deliver the West Yorkshire Health Inequalities Academy. This will include online learning resources and networking opportunities to learn together and share good practice.
• Targeted secondary prevention: We will use insight and intelligence to target interventions based on population needs that raise awareness of symptoms and improve access to timely diagnosis for:
  • Cardio-vascular disease (CVD): We will coproduce and implement targeted health checks for communities with lower than expected CVD or Diabetes prevalence and who have greater risk of CVD ill health.
  • Cancer: We will work in partnership with West Yorkshire Cancer Alliance to improve access to screening for communities with later stage diagnosis and for groups where cancer mortality is known to be higher, with a particular focus on lung cancer.
  • Lung health. We will work with partners to support equitable access to vaccine programmes that prevent respiratory ill health. We will improve knowledge of respiratory symptoms and access to spirometry for communities with lower than expected COPD prevalence and for groups with greater risk of poor lung health.

AHRC Health Inequalities Research

We are approaching the end of our 9-month, £250,000 Arts and Humanities Research Council (AHRC) and National Centre for Creative Health (NCCH) supported programme: Creating Change – building consortia to mobilise community assets to address health disparities. Working with the University of Huddersfield, South West Yorkshire Partnership Foundation Trust and Creative Minds we have brought together community and creative partners and people with lived experience across our five places as we look to secure c.£2.5m for the next phase: Collaborative community research to tackle health inequalities, exploring how the creative health work undertaken in community and cultural contexts can enhance the work of ICBs in reducing health inequalities.

Our approach to ensuring that our services are trauma informed

Adversity and trauma are experienced by all communities, but it is the most vulnerable populations that face the highest levels of adversity and trauma, and the biggest inequalities in health.

Preventing, detecting, and mitigating the impact of trauma and adversity is crucial for the health and wellbeing of individuals, families, and communities. Trauma and adversity can have long-lasting effects on a person's mental and physical health and can lead to chronic diseases such as heart disease, diabetes, and cancer.

Therefore, it is essential to prioritise both prevention and intervention in addressing trauma and adversity. While prevention strategies can help reduce the occurrence of traumatic experiences, intervention strategies are essential for those who have already experienced trauma and adversity. A parity of esteem between prevention and intervention can ensure that individuals have access to the support and resources they need to heal and recover.

Across West Yorkshire we will continue to work together with people with lived experience and colleagues across all sectors and organisations to ensure West Yorkshire is a trauma informed and responsive system by 2030.

To reach our ambition by 2030 we will:

• work collaboratively across the system with all our partners to understand our services better, understand the needs of our population and prevent re- traumatisation
• continue to support all West Yorkshire Health and Care Partnership programmes and places, ensuring strategies and plans are trauma informed and responsive by 2030, and building the foundations for sustainability beyond 2030
• work towards a culture change across West Yorkshire that includes working together to ensure that language used across the system does not further marginalise and individualise challenges faced by those who have experienced trauma
• support and work with the personalisation agenda to apply a trauma informed lens, this strengths-based approach will support physical, psychological, and emotional safety for our population and to empower people to re-establish control of their health and wellbeing, recover and live their best healthiest lives for as long as possible
• use evidence and embed knowledge of trauma and adversity in our work using the following trauma informed principles: – safety – trustworthiness – peer support collaboration – mutuality, voice, choice – empowerment and cultural humility
• seek to understand and address systemic issues such as racism, poverty, and determinants of health to reduce inequalities, adversity, and trauma
• promote resilience in vulnerable populations, leading to better health outcomes for all
• offer better care for all, through co-produced services and service development, that is equitable and accessible by identifying and directing resources appropriately
• build on existing resources and capability across the system including the development of the knowledge and competency framework and the Improving Population Health Fellowship’s Adversity, Trauma and Resilience Fellows
• work in partnership and co-produce with our communities in line with West Yorkshire Trauma Informed Coproduction Guidance, to promote and support resilient communities, who have an important role in preventing adversity and trauma
• embed the recommendations of the West Yorkshire adversity, trauma and resilience evaluation and changing systems document.

Adversity trauma and resilience objectives

• All organisations in West Yorkshire becoming trauma-informed
• Adversity Trauma and Resilience Training for all staff appropriate to job role (including managers and leaders)
• Embedding trauma informed reflective practice and restorative supervision across all organisations to support the health and wellbeing of the West Yorkshire workforce
• Parity of esteem between prevention and intervention - moving upstream, early intervention, improved access and increase investment to achieve the ambition.
• Ongoing support to grow and develop local Adversity Trauma and Resilience partnerships focused on helping our most vulnerable people.

Our system approach to preventing suicide

West Yorkshire Health and Care Partnership has adopted a zero suicide approach and has a strategy which centres on the fact that suicides are preventable deaths. Over the next five years, we will work towards our zero-suicide ambition by reducing our suicide rate by 10%. We will do this through a health inequalities lens, increasing understanding of how inequalities contributes to suicide. We want suicide prevention to be a collective effort involving all organisations, employers, sectors, and the public.

The rolling three-year aggregate rate of suicide rate per 100,000 population for West Yorkshire was at 13.2 for 2019 to 2021, up from 12.6 for 2018 to 2020. The England average rate was steady at 10.4 in both 2019 to 2021 and 2018 to 2020. With the exception of Bradford, every local authority in the region has higher rates than the England average. We have had a focus on suicide prevention for a number of years, yet the rates have not substantially reduced in West Yorkshire. We must find new approaches to reverse this trend over the next five years.

Every death is devastating for those left behind and has a lifelong impact. Being bereaved by suicide increases the risk of further suicide. The suicide bereavement service exists for anyone reading this who may have lost someone to suicide, regardless of how long ago, or the relationship to the person who died.

The West Yorkshire Suicide Prevention Oversight Group has identified gaps, based on national and local evidence. These gaps are addressed in our comprehensive Suicide Prevention Strategy, which can be found on the Suicide Prevention West Yorkshire website.

One of our biggest challenges is measuring the impact of our collective system-wide work on suicide prevention. It is difficult to attribute responsibility for driving change. To deliver our zero suicide approach, we need to make suicide prevention everyone's responsibility and incorporate it into the plans and performance framework of every organisation in our partnership and beyond. We have made progress, but now we need a fundamental shift across the entire system. Our goal is for suicide prevention to be treated as seriously as fire safety or having a first aider in every organization.

To achieve this, Suicide Prevention Oversight Group has made several recommendations including a continued focus on reducing stigma, taking a life course approach which means that prevention happens as early as possible, working and learning from people with lived experience, consideration of suicide prevention training for employees and volunteers and the continued development of suicide prevention champions linked to local action groups and networks.

We shall measure our success in achieving our suicide prevention ambition by measuring:

• Our progress using the three-year rolling average suicide rate per 100,000 people, as reported annually by the Office of National Statistics (ONS)
• The increase in the number of organisations with specific, measurable, and evidence-based suicide prevention strategies meeting minimum standards.
• The level of investment in suicide prevention across the system
• Evidenced assurance and accountability frameworks.

There are strong place-based networks and partnerships, as well as the West Yorkshire Oversight Group and Network, who can provide evidence-base, support, guidance, and peer review of organizational plans and strategies. You can contact us through our dedicated suicide prevention website.

Equality, diversity and inclusion and race equality

We know that people’s ability to live a healthy, fulfilled, and safe life is significantly affected by their social, cultural, religious, and demographic make-up. Delivering services and change that acknowledge and address this and tackling inequalities and injustice within our workforce is of paramount importance in all that we do.

Through our tackling health inequalities for Black, Asian and Minority Ethnic communities and colleagues work, for example, we know that coming from an ethnic minority background in West Yorkshire means that healthy life prospects and opportunities at work are vastly different to the majority culture. We also know, through our WRES and staff survey data, that colleagues from an ethnic minority background working across our partner organisations do not as a whole experience work as positively as their white colleagues. Experiences of discrimination are higher, feelings of equal opportunity for progression lower, and the demographic composition of the workforce increasingly less diverse going up the pay scale.

People’s identity is multifaceted, and characteristics intersect. We know that this can have a compounding impact on inequalities and recognise that in making our Partnership the best place to work we must encourage diversity and inclusion.

Critically, we also recognise that much of that which determines health and wellbeing is beyond the immediate scope of health and care services. This makes cross-sector collaborative working imperative to achieving our goals on equality, diversity and inclusion for our population and staff.

Our Partnership has a longstanding commitment to equality, diversity, and inclusion, and tackling inequalities and injustice wherever we find them. Recognising the facts of what we know and applying our Partnership’s three tests highlights inequalities present a wicked issue that cuts across the entirety of West Yorkshire and thus can benefit from at scale working and the sharing of best practice amongst system partners.

Our work to date on tackling ethnicity based inequalities and racism typifies our approach and commitment. The 8th of our 10 Big Ambitions pledges to diversify our leadership to make it reflective of our communities and ensure that poor experiences of work for ethnic minority staff are a thing of the past. Our Tackling Health Inequalities for Black, Asian and Minority Ethnic Communities and Colleagues report called us to action, resulting in significant progress in the four domains of the report across all system partners in pursuit of our ambitions. The ‘Connected on Inclusion’ report and week sought to reflect, connect, and improve on our progress and resulted in a renewed focus on and impetus for action. Progressive outcomes include making recruitment more inclusive, establishing the Fellowship, offering coaching/mentoring, a range of initiatives to tackle health inequalities amongst our population, our anti- racism movement, and more.

In recognition of the fact that much of the determinants of health and wellbeing are not related to health or healthcare, we have been working to establish several joint posts with the West Yorkshire Combined Authority that will enable progress on our collective inclusion priorities. This includes the West Yorkshire Inclusivity Champion and joint public-health roles.

Recognising the progress, we have made to date, and the foundation that has established for our equality, diversity, and inclusion journey, we know that we have more to do and further to go. We know that creating honest and open spaces to share and hear voices of those with lived experience is vital, but that action must follow.

Aligning our statutory equality and inclusion duties as an ICB with existing actions that we have committed to, such as the Connected on Inclusion report actions, coupled with our joint-working prospects with the Combined Authority present a significant opportunity. By aligning our strategic priorities and addressing these through collective endeavour we can consolidate our efforts and extend their impact. We will commit to doing so through an Equality, Diversity, and Inclusion Strategy.

Through the development of our strategy, we will build on and seek to transfer the wealth of progress made and experience held by our Race Equality Network, to ensure that our work is inclusive of all. In ensuring that this strategy aligns with the ambitions we share with the Combined Authority we will contribute to the wider inclusivity of our socio-economic environment and ensure that those factors that determine health and wellbeing are more positive for all.

There are measurable ways of tracking our progress and we must develop a framework that delivers tangible outcomes. For example, we know that on average 20% of the West Yorkshire population are from an ethnic minority background, thus we will continue to work toward ensuring our leadership reflects that and that we get things right for a significant proportion of our people.

Supporting people during the cost-of-living crisis

The cost-of-living crisis facing our country and region is more than an economic issue. It will have far reaching implications for health and care services across West Yorkshire and will impact across both the people we serve and the staff we employ. We know that financial hardship directly impacts on the mental and physical wellbeing of people, and as more people are pushed into poverty this will increase the number of people who need our support. We also know that a significant proportion of employees in our organisations, as well as carers and volunteers will also be directly affected. This is a priority for us all, and all partner organisations across West Yorkshire are taking action to support people during this time.

The actions are available in more detail here however, the collective actions we have agreed collectively with the West Yorkshire Combined Authority (WYCA) are focused on:

• Reducing costs to households and providing support to employees in financial hardship
• Investing in voluntary and community sector organisations
• Ensuring mental health and suicide prevention services are providing the appropriate support
• Ensuring that services are proactively responding to the impact of the cost-of- living crisis

The oversight of joint work is managed through the Improving Population Health Function at ICB level, supported by a steering group comprising of the ICB, WYCA, Local Authorities and VCSE partners. The Combined Authority is also taking action by supporting businesses with funding for energy efficiency measures, and reducing the cost of travel by bus, in addition to implementing the Mayor’s Cost of Living Fund.