It’s an often-stated fact that the COVID pandemic has widened inequalities. This is stark when you consider the position for the North of England.
The political response to this is the ‘levelling up’ agenda.
The scale of challenge ahead for communities in West Yorkshire is set out in recent reports from the Northern Health Science. Firstly A Year of Covid in the North showed 17% higher mortality from COVID-19; overall mortality was 14% higher; and COVID-19 care home mortality was 26% higher. Preventable factors such as higher deprivation and poorer underlying health explained half of the COVID-19 differences and two thirds of the all-cause mortality differences.
This is shocking but not surprising. As CEO for a large integrated care system, serving 2.4 million people, the starting point for me is that everyone should have every chance to have the best start in life, with every opportunity to live a long, happy, healthy one. This is demonstrably not the case, with variations in healthy life expectancy of over 20 years and life expectancy gaps of over a decade.
The scale of challenge for the next generation is clearly articulated in the second report from The Northern Health Science Alliance: The Child of the North: Building a fairer future after COVID-19 report, published December 2021. Children in the north are more likely to die under the age of one; more likely to be living with obesity; missed more schooling than their peers elsewhere in the pandemic; reported being lonelier (23% v 15% in the rest of England); and are more likely to be in care. This needs a response based on employment, poverty, education, and connectedness.
If you’re a child or young person 18 years or under living in West Yorkshire, you are almost three times as likely to live in a poorer area of England than the average. In West Yorkshire, children and young people are more likely than any other age group to live in the most ‘deprived population decile’ (higher crime, lower-income, worse access to services). 28.7% of our 0–18-year-olds live in these areas.
In West Yorkshire we know that intersectionality is also a factor. For example, a high percentage of children and young people from ethnic minority communities, have poorer adult health outcomes and less access to services that are important for a life course approach.
As a Partnership, we know real change happens in real work. We cannot continue to admire the problems we face; we must act. Our independent race review (October 2020) highlighted the need for broad actions on wider determinants, access, leadership and mental health care for the 20% of the population from an ethnic minority group.
The review, connected to our 10 big ambitions, has progressed in two ways. The first tackles injustice and inequity facing our workforce. We have 580 organisations/allies in an anti-racist movement, fellowships for talented under-represented groups to further career progression, and race networks represented at the highest levels of governance and decision making. The second is progress that directly addresses and tackles inequalities facing ethnic minority communities in West Yorkshire. Here we have changes to service delivery models and tackling backlogs. Our Connecting on Inclusion Report sets out the impact to date and the work to do.
This issue of race equity is a standing item on our politically led Partnership Board. This not a fad but a fundamental priority that will take time to address. The value of place-based working importantly strengthens the role of local democracy, elected members and accountability to communities. As a partnership with local authorities, we scale up anchor institutions programmes that promote community wealth building, social value, and better jobs in disadvantaged communities.
As equal partners, we remain fixated on tackling real issues. For example, across West Yorkshire 169,000 households, 18% of the 2.4 million people (Source Gov.UK Sub-regional fuel poverty data 2021), are having a difficult choice to make this winter on whether to spend money on fuel or food.
The impact of cold homes is estimated to cost the NHS £2billion every year in England and Wales, with people needing extra care from their GP and hospitals - for example, admissions for COPD are four times more likely in winter months. That’s why we invested an extra £1million to help keep people warm this winter. Alongside this, poor air quality is attributable to around 1 in 20 deaths across West Yorkshire with associated geographic inequalities, this coupled with the health and care sector’s significant carbon footprint has made climate change a priority for our work.
As the largest employee across the area, with an impressive regional innovation and med tech industry, we are in an ideal position to develop good jobs for good health. The importance of councils in their place leadership role and the strength of our partnership working, for example in health and the economy is embedded in our industrial strategy and our health and wellbeing strategies - and we are developing greater connections into our communities to ensure students know there are over 300 tech roles that may be for them.
We can create a legacy of economic growth led by solid partnerships with others, such as local enterprise partnerships for economic development, Leeds City Region Enterprise Partnership, Leeds Academic Health Partnership, Health Education England, and universities. We are developing a regional Fair Work Charter bringing together our aligned values and support for a fairer civil society with the West Yorkshire Combined Authority.
Like other parts of England, we have seen longstanding issues with pay for social care staff coming to a head and having a knock-on effect staffing care services. This is contributing to people waiting longer for hospital discharge and community care, alongside variations in experience of services. The single biggest factor affecting staff turnover is basic pay, closely followed by feeling valued. We have started to address this, bringing forward the national living wage uplift for care home staff to December 2021 funded through investing £12million of NHS funding and developing a ‘People Plan’ that develops and values all colleagues and volunteers.
Importantly, to really ‘level up’ we need to listen to the concerns of neighbourhoods, alongside funding and travel initiatives which increase the level of control people have over their life circumstances and employment choice.
This is one of the reasons why we have worked with voluntary community social enterprise colleagues to distribute funds to tackle loneliness, health inequalities, and green social prescribing and why we listen to our combined authority partners on infrastructure and transport to ensure we address hidden rural poverty and distances to access services.
Integrated care systems are more than an NHS construct. By embracing the opportunities of their wider partnerships, they are an ideal vehicle for ‘levelling up’. This will require leadership, reform, courage, and resources.
Rob Webster CBE is CEO-Designate, West Yorkshire Health and Care Partnership, an integrated care system