Local health system puts addressing inequality at heart of recovery plan

Hackney and the City of London’s health and care organisations are pledging to put addressing health inequality at the heart of their approach as they move to a “restoration and recovery” phase of the coronavirus crisis.

A report drawn up by System Operational Command (SOC), which is made up of local authority, health and voluntary sector organisations, pledges not only to “fully restore” delivery of services during the ongoing pandemic, but to “reshape long-term ambitions in a new context”.

To that end, residents in City & Hackney are told to expect a “shift in resource” to focus on prevention, wellness and population health outcomes as opposed to illness, with care increasingly based closer to home and outside of institutional settings where appropriate – the priority being to keep people healthy, independent and out of hospital.

The report on the plan reads: “The terrible toll exerted by the Covid-19 pandemic serves as another reminder of the deep social and economic inequalities which affect the health and wellbeing of our local populations.

“The organisations that make up City & Hackney’s local health and care system remain committed to a long term change programme which will move our focus from health and care service provision towards a better understanding of and response to the wider determinants of health, achieving more effective outcomes for local people and responding more holistically to the complexity of their needs, and to the specific needs of different local populations.

“Our vision of integrated care supports frontline staff to work with local people, harnessing their strengths and connecting them with resources to support their wellbeing, and advocating on behalf of our most complex and vulnerable service users.”

The report goes on to stress the importance of increasing capacity to meet demand for mental health services following predictions of a 30 per cent increase in need for services across London –  services that are still operating at reduced capacity due to high staff sickness levels.

According to the report, investment into mental health is also “largely on hold” while contracts and financial flows are clarified.

Minority ethnic groups, along with older people, men, people with underlying health conditions, those in particular jobs or living in deprivation, have borne the brunt of the pandemic disproportionately, with the most vulnerable people and communities hit hardest by lockdown and social distancing.

SOC is understood to be making sure that services will resume during Phase Two of the pandemic as well as being accessible and safe, with patients aware of any changes and any equalities impact of them being both “considered and addressed”.

Concerns have been raised recently around the impact of increased levels of virtual consultations on those unable to easily access the internet.

Under the plans, all organisations providing health and care services will have to demonstrate that emergency resilience and surge plans will be in place in preparation for a second wave of Covid-19 infections.

Speaking at a recent Health in Hackney scrutiny commission, Professor Kevin Fenton, regional director at Public Health England (PHE) London and contributor to his organisation’s report on the virus’ impact on different ethnic groups, made clear that “structural issues including racism, discrimination, stigma, distrust [and] fear” underpinned disparities suffered by ethnic minority communities in coronavirus’ spread.

Fenton added: “We need to think about factors which increase severity, such as uncontrolled diabetes, obesity, hypertension, cardiovascular disease.”