Agenda item

The report of the Director of Public Health provides an update on the Marmot - Fairer Leeds programme at the end of Year one.

The report of the Director of Public Health provided an update on the Marmot - Fairer Leeds programme at the end of Year one.

In attendance for this item were:

·  Tim Fielding – Deputy Director, Public Health

·  Sarah Erskine – Head of Public Health

·  Dr. Tammy Boyce - Senior Research Associate, Institute of Health Equity

The Director of Public Health provided an overview, noting, the Council had entered the second year of a partnership with the Institute of Health Equity who were assisting with the adoption of the Marmot City programme and data analysis. Leeds was committed to adopting the Marmot City programme and the Board had oversight of the progress, with a drive to address health inequalities and social determinants for health. The update was provided to Members to outline the progress and reflections of the first year’s development which informed the second year.

The following information was highlighted to Board Members:

·  The programme had accountability with the Board and was to align with wider Council strategies. There was also a balance in analysing data and having focused action to address health inequalities supported by a systematic approach.

·  The first year had raised aspirations, identified inequalities and social determinants of health and was the foundation for a long term project.

·  Notable social determinants included gaps in life expectancy driven by deprivation, increased child poverty and a more diverse population living in IMD decile one and increases in the numbers of children receiving free school meals. There was a rise for poverty ‘in work’, driven by low wages and income inequality.

·  Compared to other core cities, Leeds measured unfavourably across some areas, related to poverty and health inequalities. Local recommendations were to focus on inclusive growth, with a refreshed strategy noted to be a good basis for influence and should go further to encourage employers to pay better wages and lift people and communities out of deprivation.

·  Leeds data displayed low temporary accommodation occupancy with homeownership increasing and a fairly healthy private rented sector market.

·  The Leeds data for children considered to be a healthy weight showed that the obesity rate for children was above the UK average.

·  Physical activity rates for adults aged over 50 was fairly low and ways to improve this were outlined. 

·  The Institute of Health Equity had made fifteen recommendations, contained from page 59 of the report, to address health inequalities in Leeds under three aim headings; increase accountability, existing and future partnerships prioritise health equity and drive more effective interventions and evaluations and implement Leeds Marmot indicators.

·  The eighth recommendation addressed differences in health outcomes for ethnic minorities. ‘Ensure that the needs of ethnic minority populations in Leeds are addressed in all citywide strategies to reduce inequalities.’

·  Greater accountability and sharing good practice were required to identify what works to reduce health inequalities across the health and social care system.

·  Using indicators, monitoring data, successes and failures and strong leadership were essential to improving public health outcomes.

·  The first year of the Marmot programme had engaged with the Housing department, liaising with Senior Housing Managers, to identify where improvements were needed.

·  The recommendations focused partnership work to scale up what works and share best practices.

The Board discussed the following matters:

• Emerging health inequality data after the Covid-19 pandemic had displayed an increase, particularly within inner city areas and also for ethnic minorities.
• As the findings had focused on partnership working, it was outlined that a wider range of partners should be involved including business, third sector and academia as well as schools and wider employers.
• The Leeds Learning Alliance were noted as a relevant partnership to potentially help ambitions in addressing inequality in social care and also schools were a good space for families to raise issues and access care.
• The approach was proposed to be aligned to existing structures and services to embed the Marmot programme throughout the system. The process for doing so was discussed at working groups as an ongoing challenge as there still needed to be clear direction for accountability.
• There were radical changes needed to address health inequalities relating to housing, with selective licensing being utilised to ensure effective management of private rented properties in areas of deprivation.
• Work and employment related issues were alarming, with poverty for people in employment increasing. This was apparent in schools with the eligibility for free school meals rising significantly, which was a knock-on effect of low wages.
• The roll out of the work started in Lincoln Green was cited as an example of best practice. This was being developed city-wide to target people in deprived areas into good jobs in health and care and had the potential to be scaled up across different types of work.
• Partnership work, especially engaging with housing providers was essential to understand what services were missing. Better links with housing providers would identify gaps in operations and allow evaluation of the approach to inform the programme. Communication with tenants to understand the experience of selective licensing and attempt to take pressure off the poorest people was integral.
• The statistics were useful but lived experience was a powerful tool, particularly from less heard voices
• An infographic detailing lived experience consultation, created as part of the Institute of Health Equity review, was agreed to be shared with Members.
• Existing insight into people’s experience living in Leeds had informed all iterations of the Marmot reports.
• Better connections between LTHT and Children’s Services were suggested including better support for parents and understanding of life-course based approaches. A conversation across the Health and Wellbeing Board and Children’s Board was suggested.
• The role of the third sector and community services was outlined as being essential, rooted in an approach based on prevention and early intervention. The challenges of funding and the rush to develop new projects when existing third sector ones were struggling to be mainstreamed was noted.
• In summary it was noted that to further develop partnership working a change in culture, with everyone focused on health inequalities was needed. This should involve the identification of gaps, understanding the evidence and the importance of scaling up projects that have the greatest impact.

RESOLVED –

a)  That the progress of the Marmot - Fairer Leeds programme in Year 1, be noted.

b)  That the findings of the IHE ‘Whole system review’ and commitment to supporting delivery of the IHE recommendations, be considered and noted.