HBC progresses campaign to reduce health inequalities

Tackling health inequalities rooted in deprivation is a priority for Hastings Borough Council. This is an issue which calls for much more than just healthcare, so the campaign brings together many players. Various initiatives, some of which are due to produce results soon. Text by Nick Terdre, research and graphics by Russell Hall.

Hastings Borough Council has committed itself to work for a reduction in the health inequalities which blight the lives of many of Hastings’ inhabitants. The signal was sounded in February 2021, when HBC passed a motion calling for, among other measures to improve the delivery of healthcare, a “unifying strategic plan to eradicate severe health inequality from our Borough by 2029.”

This commitment coincided with a hard-hitting report on health inequalities in coastal communities by the UK’s chief medical officer Chris Whitty, which included a case study on Hastings (see box).

Last year the council added health to the culture, tourism and leisure portfolio of Cllr Andy Batsford, who told HOT that the fundamental barriers to healthcare for many residents have not changed in 20 years, nor have they seen any movement in their chances of living longer, healthier lives.

Health in all policies

A ‘health in all policies’ approach was also adopted, to ensure that health inequalities are embedded in planning, policies and practice. It will therefore feature in the new Local Plan when it is published.

HBC has no statutory duty for health, Batsford said – this lies with the county council, which takes a broad brush approach, believing all should get an equal share of health resources. This will not improve the situation, in Batsford’s view. “What we need is to focus hard, long-term resources in the poorest areas. We are looking to build partnerships, and to always call out that resources need to come here.”

Scatterplot showing how neighbourhoods in Hastings score much higher on measures of deprivation than those elsewhere in East Sussex.

Under the latest reorganisation of healthcare services, the overarching body in the health sector is NHS Sussex, one of 42 Integrated Care Boards which have replaced the regional Clinical Commissioning Groups in England. “NHS Sussex are interested in reimagining healthcare at a local level, bringing in the lessons learned in combating Covid and a much more community-based way of working,” said Batsford.

“They have promised financial skin in the game and a new way of working. They even brought their board down here and the new director was very serious about Hastings very much being on their radar.”

The key forum for overseeing action is the Local Strategic Partnership, which, chaired by council leader Paul Barnett, brings together representatives of the council, healthcare, community, business and the voluntary sector. This collaborative policy, known as the ‘whole systems approach,’ is an acknowledgement that the issue of health inequality is not a matter only of healthcare and medical treatment, but has many dimensions, economic, political, social and cultural, and needs to be tackled by collective action involving players from diverse sectors bringing diverse experience and skills to bear.

In June 2021 the LSP set up the Hastings Health Equity, Wellbeing and Prosperity group, which a year later presented eight recommendations intended to provide a “roadmap to creating health equality, wellbeing and prosperity” in the town.

Defining health inequalities

So what exactly does the term health inequalities refer to? They arise due to unfair and avoidable differences in health across the population, and between different groups within society.

Thus they are closely correlated with economic deprivation. Hastings is one of the more deprived towns in England, ranking 13^th highest in the government’s 2019 Index of Multiple Deprivation, and the 46^th most deprived for health and disability out of 317 areas.

There are parts of Baird, Castle, Central St Leonards, Gensing, Hollington, Ore, Tressell and Wishing Tree wards which fall within the 10% most overall deprived neighbourhoods (lower super output areas - LSOAs) in the country, while a fifth of neighbourhoods are in the 10% most health deprived.

Levels of poverty, including food and fuel poverty, and sub standard housing are greater in these areas, leading to a greater prevalence of ill health, notably circulatory and respiratory diseases, self-harm, teenage pregnancies, as well as damaging life-styles including smoking and excessive alcohol consumption, drug dependence and inadequate and inappropriate diet.

Also included in the mix are mental problems. The report to the LSP meeting in June last year refers to the “chronic stress that comes from living with unstable incomes, jobs and housing. When someone is constantly worrying about how they are going to pay rent, or if they will still have a job tomorrow, it can cause anxiety, depression, and other mental health issues,” which in turn “leads to increased risk for illness…”

Health inequality also encompasses second-class treatment under the NHS: barriers in accessing services due to inadequate numbers of GPs and other healthcare staff in deprived areas, who in many cases prefer to live and work in better-off communities. In the face of the difficulties in arranging appointments, many people simply give up using healthcare services. For this reason, the rate of emergency hospital admissions tends to be higher in these communities.

Many of these problems have been exacerbated by the Covid-19 virus, which also proved to take a greater toll of ethnic minority communities. And while the effects of Covid have receded in recent months, the precarious conditions in which many poorer people live have been worsened by the rising cost of living.

Health inequalities reduce people’s life chances, leading to a life expectancy gap with better-off groups. The latest analysis of ONS death registration data and mid-year population estimates by the Office for Health Improvement and Disparities, based on data covering 2016-2020, shows the largest gap across Hastings wards is 7.9 years for men, between Gensing (74.5 years life expectancy) and Old Hastings (82.4), and 8.5  years for women, between Gensing (78.7) and Ashdown (87.2).

The gap is narrower than it was but still significant. And life expectancy in Hastings still ranks well below the England average.

Mike Turner fund

Unusually, HBC has become the recipient of £3.4m to invest in tackling health inequalities. The money, which had previously been identified for spending on health programmes in Hastings and Rother, was re-allocated in 2021 as legacy funding following lobbying by Cllr Mike Turner, the HBC representative on the East Sussex Health Overview and Scrutiny Committee.

In 2021/22 £1m of the so-called Mike Turner fund was invested in short-term schemes aimed at reducing health inequalities on six fronts:

• Children and young people’s mental health support
• Parental advice and support
• Activity and exercise via the Active Hastings programme
• Autism training for health and care staff
• Support for street drinkers
• Work to reduce the use of dependence forming medications.

The remaining £2.4m has been allocated to the Universal Healthcare programme, along with funding from central government and other sources. This is a pilot project being run by London South Bank University in Hastings and Bradford aimed at developing new ways of designing and delivering NHS services that overcome the drawbacks of unequal access to services.

Input has been gathered from residents living in areas suffering health inequalities and a number of workshops have been held leading to the development of several prototypes - proposed methods for achieving the project’s aims - which in January were due to undergo testing over a six-week period. (See explanatory video.)

Prototypes that are shown to work successfully will be considered for adoption by the NHS on a national scale.

Whole systems approach

Another initiative, to develop the logic of the whole systems approach, is being undertaken by the Hastings Health Equity, Wellbeing and Prosperity group established by the LSP. A seminar was held last September to map out the way ahead; Chris Whitty attended and gave the keynote address.

It is understood that a roadmap was due to be agreed earlier this year and it is expected that an update, along with an update on the Universal Healthcare project, will be given to the LSP meeting scheduled for 24 April.

The council’s programme in Broomgrove, which is being funded by Hastings’ £1m allocation from the UK Shared Propserity Fund, is also targeting health inequalities, according to Cllr Batsford - a second article will look at this initiative.

Previous initiatives to tackle health inequalities include the Healthy Hastings and Rother programme mentioned above, which was set up in 2014 by the Hastings and Rother Clinical Commissioning Group. Encompassing 46 projects, it was originally intended to enjoy funding of £5m a year over eight years, but this lofty level dramatically declined once the pandemic emerged and overall spending eventually amounted to £11.4m, or £1.4m a year on average.

Some of the programmes were adopted as normal practice by the NHS once the initial funding ended.

Positives

The evaluation report by independent consultants found much positive to write about. Of the 24 projects assessed in detail, 15 had evidence of significant outcomes being achieved, and another seven some evidence.

The report recommended that the area should continue to “deliver a dedicated health inequalities programme,” but that this should be run by a broad, multi-sector strategic partnership” including the CCG (now the Integrated Care Board), local authority public health team, district and borough representatives, and key members of the voluntary and community sector - as is happening.

It also threw up some lessons that need to be taken on board in current work. Seven of the projects could not be evaluated as no data files could be found. They may have been successful or not - but by failing to keep data, all that effort appears to have been in vain when it comes to assessing their effectiveness.

As well as proper record-keeping, it is also essential to establish objective criteria for assessing the results of initiatives. If the many fine words spoken about the aspiration to reduce health inequalities are to mean something in practice, there must be a hard-headed approach to evaluating the results of projects, pilots and other initiatives.

As well as proper record-keeping, it is also essential to establish objective criteria for assessing the results of initiatives. If the many fine words spoken about the aspiration to reduce health inequalities are to mean something in practice, there must be a hard-headed approach to evaluating the results of projects, pilots and other initiatives.

And the sense of urgency which previously informed the council's utterances has dissipated in recent months. The updates on the progress of the Universal Healthcare programme scheduled to be given by CEO Jane Hartnell to the November and March Cabinet meetings were missing, without comment - the reason for which she declined to give to HOT - and now the LSP meeting on 24 April, when updates on the overall campaign were expected, has been put back to 5 June.

The scores for a range of health indicators for each Hastings lower super output area or neighbourhood in 2004-2019 can be found here, with explanatory notes by Russell Hall.

 

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