Agenda item

Sarah D’Souza, Director of Communities, NHS North Central London ICB introduced the presentation on NCL Inclusion Health Needs Assessment alongside Alexandra Levitas from Public Health at Islington Council.

The following points were noted in the discussion:

·       People in Inclusion Health groups face the most significant health inequalities of any group in our population; often compounded by the impact of intersectionality/multiple disadvantage. The average age at death was 46 years for people experiencing homelessness. This is 30 years below national average. There were high levels of early frailty across this group.

·       Please in inclusion health groups also had a high level of complex health needs. This could be associated with childhood trauma, mental health issues, drug and alcohol use, sexual health, infectious diseases, poor perinatal outcomes, or the impact of violence.

·       There could be complex barriers to accessing planned healthcare, including stigma and discrimination, lack of trust, trauma triggers, rigid appointment systems, digital exclusion, language barriers, and travel costs. These were compounded by lack of visibility within our system. Early intervention and joined up approaches were needed to support those with complex needs.

·       The Inclusion Health Needs Assessment included three phases in the work which aimed to solidify our understanding of the inclusion health groups. Phase 1 included a rapid evidence review which reviewed over 100 local and national data sources and meetings and correspondence with 20 stakeholders. Phase 2 included a frontline staff survey and key stakeholder interviews. This considered overlaps of severe multiple disadvantages using existing data and lived experience interviews and considering service user journeys. Phase 3 involved the preparation of the final report to synthesise all evidence sources.

·       There was a high prevalence of multiple disadvantages among those in inclusion health groups. The needs of the homeless community were well understood but there was a gap in understanding and service provision for sex workers and GRT communities.

·       There were gaps in access and experience to services for those in inclusion health groups, including mainstream primary care, mental health services, and dental services. Experiences in hospitals and discharge pathways could be improved. Better coordination was needed around release from prison.

·       There were pockets of excellent practice, including integrated working,  collaboration, and partnership with mental health services.

·       There was a need for greater education and awareness of inclusion health groups.

·       The Board noted case studies of those in inclusion health groups experiencing multiple disadvantage.

·       There was a need to consider how health partners worked together to address the issues raised in the report. It was recommended to consider how services are provided to inclusion health groups, particularly access to dental health and physiotherapy. There was a need to consider integrated approaches for sex workers and vulnerable women from inclusion health groups, as well as a coordinated approach to prison release and access to mainstream primary care.

·       The proposed next steps included building on existing work with asylum seekers to develop an approach to inclusion health groups, to further consider co-production, to further develop services for sex worker and vulnerable women in light of the Violence Against Women and Girls work. On a system-wide level, there was a need a build an accountability network of inclusion health leadership and enable cross borough/system working on priorities.

·       The Board considered the need for more information on looked after children and further information on financial resourcing and how this is allocated across the ICB and NCL, as well as the joining up of resources and the priorities. It was suggested that a business case could be developed by working with partners to set out priorities, pressures and set out financial investments.

·        It was suggested that this work be taken to the Police, prisons and probation service for review.

RESOLVED:

a)     That the scope and the Phase 2 report findings,  and an overview for developing plans for taking forward recommendations and actions, be noted;

b)     To consider the additional opportunities for Islington to use the insights from the Inclusion Health Needs Assessment to improve outcomes for inclusion health groups;

c)     To consider how support from the wider North Central London system can assist with Inclusion Health within the borough.