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 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

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. WY’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.

Poverty and the cost-of-living crisis

The cost-of-living crisis facing our country and region is more than an economic issue having far reaching implications for health and care services across WY impacting both the people we serve and the staff we employ. A significant proportion of employees in our organisations, as well as carers and volunteers will be directly affected.

The actions are available in more detail here however, the collective actions we have agreed with the WY 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.

Housing and healthy places

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. Inefficient housing is one of the biggest contributors to the greenhouse effect in the country.

Our Housing and Health Partnership has worked to facilitate sharing of good practice across the five WY places. The core objectives 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
• Reducing the number of children living in fuel poverty across WY.

Economic growth and innovation

We will  work closely with the WYCA to embed health and health inequalities as a consideration for any growing business or start-up. We will promote local procurement practices within anchor institutions of each local area, including healthcare organisations.

As described earlier, we will work to address poverty and the cost-of-living across the region with a coordinated approach involving public sector, third sector, the WYCA and local businesses. We will 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 or 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, with a particular focus on the groups who may currently experience barriers in accessing employment
• Promote fair work across the region
• Strengthen and grow volunteering pathways into employment across the Partnership.

Transport

Our work with WYCA will develop sustainable routes of transport to healthcare organisations across the region and consider the impact on health of all future transport infrastructure and planning. We will promote sustainable transport and travel programmes for culture and social value and promote sustainable travel where appropriate.

Meeting the climate change challenge in everything we do

Climate change has 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 WY to act to reduce our environmental impact, but also to prepare for the changes that are already taking place and will intensify in future.

Focusing on climate change continues to be challenging. Failure to address our societal and environmental responsibilities will lead to increasingly frequent and severe emergencies. In WY, we have an ambitious Climate Change Strategy 2022-2028. It 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”.

NHS Green plan

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

Prevention

We will continue to focus 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. 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 increase 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. We will 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.

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. 

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, WY 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.

• 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

ICBs are one of the five duty holders and as such are required to work together to prevent and reduce serious violence.

• We will continue to use our established partnership with the WY Violence Reduction Partnership (VRP) to respond to the requirements of this duty, building on existing work with the aim of further reducing incidents of serious violence
• We will continue work in partnership with the WY Violence Reduction Unit (VRU) 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 settings
• We will work across the Partnership to support the coproduction of a Serious Violence Needs Assessment and Response Strategy.

Tobacco

• We will work to ensure that our services reach people in the most deprived communities of WY, and those at increased risk of disadvantage. To do this we will explore expansion of tobacco dependency services into one emergency department in WY initially, with a view to supporting full roll out if successful.
• We have established and will continue to support the WY Tobacco Control Alliance.
• We will coordinate the ‘swap to stop’ programme across WY, ensuring that we reach people who would not ordinarily access smoking cessation services.

Alcohol care teams

• We will continue to support Bradford Teaching Hospitals NHS Foundation Trust and Mid Yorkshire Teaching 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 WY 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.

Domestic and sexual violence

• We will continue to work in partnership with colleagues across WY 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 WY ICB overlay with national requirements of CORE20Plus5 in relation to population groups and clinical areas of focus. This also includes national requirements of CORE20Plus5 for children and young people.

Over 20% of our population live in the most deprived areas, compared to 10% nationally, and it is likely that delays caused by the pandemic and increasing fuel and food poverty in our places has worsened. Children and young people in WY are more than twice as likely to live in the most deprived areas compared to the national average and we recognise a notable percentage of children and young people from Black, Asian, and Minority Ethnic backgrounds are living in these deprived areas.

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

Our collective WY approach to reducing inequalities will focus on fourspecific areas:

• 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;
• Increasing partnership capability to reduce health inequalities through our Health Inequalities Academy;
• Demonstrating action, impact and improvement on inclusion health through the WY Inclusion Health Unit. Key areas of the Unit align to the NHS England Framework for Action on Inclusion Health;
• Reflecting WY ICB’s commitment to hearing and responding to the voices of people with lived experience, an Inclusion Health Community Board will be developed in 2024. The Community Board will ensure that the voices of people with lived experience and the VCSE partners that support them have strategic influence over the strategic approach for inclusion health. 

Inclusion health

• We will improve what we know about inclusion health groups, including their population size and health needs.
• We will influence condition-specific programmes identified as priority areas to better meet the needs of inclusion health groups.
• We will review and improve the quality, effectiveness, and parity of inclusion health service provision across WY.
• We will build an evidence base for ‘what works’ in terms of service design and intervention, supporting improved decision-making based on research and intelligence.  
• We will support a representative workforce across WY, who are supported, skilled and capable to serve inclusion health groups.
• In order to embed lived experience, we will implement a WY Inclusion Health Community Board in partnership with local VCSE organisations and Experts by Experience.
• We will continue to maintain our status as a Partnership of Sanctuary through the delivery of a cross-system action plan.

Leadership capability

• We will continue to deliver the WY Population Health Fellowship with the delivery of projects on health inequalities, trauma, and climate change.
• We will continue to develop and deliver the WY 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), cancer, lung health and vaccination.  Details of the work we are undertaking is set out in detail throughout this plan.

Reducing health inequalities for children and young people

In addition, we will continue to undertake targeted work to reduce health inequalities for our children and young people.  In particular we will be focusing on asthma, diabetes, epilepsy, oral health and mental health.  Detailed overviews of our plans in these areas are set out in the relevant sections of this plan. 

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. 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 WY we will continue to work together with people with lived experience and colleagues across all sectors and organisations to ensure WY 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 WY 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 WY 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 WY 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 WY adversity, trauma and resilience evaluation and changing systems document.

Our system approach to preventing suicide

WY Health and Care Partnership (WYHCP) 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.

Rolling aggregate three-year suicide rates show the overall rate for WY reduced slightly from 13.0 per 100,000 people in 2019-2021 to 12.5 in 2020-2022. This remains higher than England’s average rolling three-year rate, which for 2020-2022 was 10.3, slightly down from the 10.4 for 2019-2021.

Being bereaved by suicide increases the risk of further suicide. The suicide bereavement service exists for anyone who may have lost someone to suicide, regardless of how long ago, or the relationship to the person who died. The WY 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 continue 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 organisation.

To achieve this, our 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, delivery 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).
• How partners within the WYHCP are supported in reducing suicide among their staff and volunteers.
• Progress in making suicide prevention everyone’s business.
• How we improve system-wide information sharing around suicide prevention.
• Performance of specific work targeting resources where suicide risk is the highest, and where it makes most sense for work to be done at a systems level.

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.

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 WY, 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 sought to reflect, connect, and improve on our progress and resulted in a renewed focus and impetus for action.

Progressive outcomes include making recruitment more inclusive, co-designing and delivering the Fellowship for diverse leadership programme, offering coaching/mentoring and training a cohort of coaches from ethnically divervse backgrounds, a range of initiatives to tackle health inequalities amongst our population, our anti- racism movement, and more.

In recognition of the fact that many 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 which we will pubish in the Autumn. 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.