Agenda item

Councillor Julie Dore, Co-Chair of the Board, introduced a discussion paper entitled Tackling Health Inequalities in Sheffield, which set out what each of the constituent organisations on the Health and Wellbeing Board was doing to address health inequalities. She outlined the work of the Fairness Commission in relation to inequalities and the Commission’s recommendations to address inequalities.

The Health and Wellbeing Board was asked in this, the first of two discussions on health inequalities, to consider each of its constituent organisations’ responses to health inequalities and to identify additional action as appropriate.

Councillor Dore introduced Professor Alan Walker, the Chair of the Fairness Commission, who gave a presentation concerning the first annual review of the impact which the Fairness Commission had made.

Professor Walker stated that the stance which the Commission had taken was particularly bold – to make Sheffield the ‘fairest city’. There were 4 targets specific to the remit of the Health and Wellbeing Board and a wider set of targets relating to mental health and wellbeing and carers. He outlined the responses of all the relevant organisations, those matters which were outstanding and the related principles. Professor Walker outlined the challenges to the Health and Wellbeing Board, namely (i) a need to tackle premature deaths of people with learning disabilities and severe disabilities; (ii) to develop a life course strategy, to embed prevention including health care and quality of life. He stated that mental illness was responsible for causing early deaths (of up to 20 years earlier) and also increased the risk of a person suffering from one of the top five health related killers. It was important, he said, to be ambitious about tackling inequalities.

The Board discussed matters raised by Professor Walker and in relation to health inequalities, as summarised below:

A major discussion was required to respond to these challenges and as to how organisations can pull together in taking actions which reduce inequality. Reducing inequalities was a strand which ran through the City Council’s strategies, including in the Corporate Plan and the budget and the food and physical activity strategies.

The mental health of adolescents was important as was the impact on children and young people who were living in households which included people with poor mental health or with a mental illness. 

The shortened life expectancy for people with a mental illness was particularly stark. There was a role for GPs in providing health checks and for health and social care in the way that personal budgets were applied to a person’s recovery or in helping them to manage mental illness and physical health.

The Rt Hon Andy Burnham MP, having attended the meeting for this item of business, stated that it was a privilege to hear the quality of the conversation and the level of challenge in the Board’s discussion. He referred to the concept of a social model of support encompassing the whole person and observed that mental health should be moved to the centre of the health and social care system. At present, Child and Adolescent Mental Health Services (CAMHS) received only a small proportion of the total funding available to the NHS and Local Authority and there was a shortage of crisis prevention services. There was a shortened life expectancy of up to 20 years for people with mental illness. He encouraged the Board to make representations with regard to the weighting of health funding to areas with greatest need and health inequalities. He stated that Labour was developing policy around full integration and commissioning and was beginning discussions in this regard. He referred to the forthcoming report by John Oldham on whole person care, due to be published in February 2014.

The Chair, Dr Tim Moorhead, clarified that the Board had made representations on this issue and had briefed two of the City’s local MPs, David Blunkett and Clive Betts in this regard. He stated that the NHS also had a duty to take action with regard health inequalities. In reference to the report on whole person care, Dr Moorhead stated that the Board would like to engage with this work.

Comments were made by other members of the Board as follows:

The City Wide Learning Body was developing a project on young people’s mental health and the transition from child to adult services and support which supported the notion of a life-course strategy.

Whilst infant mortality was reducing, there were inequalities within that overall reduction, in such areas as maternal smoking. Breastfeeding was an area in which there had been successful improvement in performance and the question was how improvement could be sustained and problems arising from the widening funding gaps could be mitigated. 

The Fairness Commission viewed the Health and Wellbeing Board as the strategic lead on the issue of health inequalities and the translation of strategy into next steps. The tasks were to turn around inequalities and to bring about prevention in future generations, which required a joined-up perspective.

Systemic change would need a long term vision and there were already changes to the role of GPs, for example. Action such as health risk assessments for those people who might not have previously been identified as ‘at risk’ was being encouraged by GPs as commissioners. However, there was always a time lag in implementing change and seeing its full effect.

Healthwatch Sheffield was in a position to rapidly identify health inequalities by asking people and listening to them.

Health inequalities were the consequence of socio-economic factors and the Board should be realistic about what it could achieve. Much could be done to mitigate the effects of inequalities on health, although these might not equate to a coherent set of actions, a fact of which Professor Walker had reminded the Board. There were short, medium and long term actions necessary. In the short term, action should be taken for people who may die in the next 5 years. In the medium term, things should be done to stop people from developing illnesses, which might include lifestyle and in the longer term, the root causes of ill health needed to be addressed.

We should be mindful of the scale of effort required to bring about health improvement. For example, the prevention of heart disease required a city wide initiative, encouraging GPs to identify those with a high risk of heart disease. With regard to mental health, it was recognised that many of the actions necessary had not taken place.

It would be helpful to turn the numerous strands of work into a coherent and powerful collection of actions, in relation to which all organisations played a role. Addressing the gap in provision for mental health and learning disabilities should be identified as an objective.

RESOLVED: That the Board (a) thanks Professor Alan Walker for his attendance and contribution; (b) requests the Director of Public Health to produce a Health Inequalities Action Plan; and (c) requests that a further paper on health inequalities be submitted to the Board in Spring 2014.