Corporate report

UKHSA Advisory Board: Equalities, Ethics and Communities Minutes

Updated 9 May 2024

Date: 8 May 2024

Sponsor: Graham Hart

1. Recommendation

The Advisory Board is asked to note the minutes of 23 January 2024 meeting of the Equalities, Ethics and Communities Committee. The minutes were agreed on 30 April 2024.

2. Minutes (confirmed), UKHSA Equalities, Ethics and Communities Committee, 23 January 2024

Present at the meeting were:

• Graham Hart – Non-Executive Member of UKHSA Advisory Board (Chair)
• Susan Hopkins – Chief Medical Advisor (Executive Lead)
• Marie Gabriel – Associate non-executive member
• Mark Lloyd – Non-Executive Member of UKHSA Advisory Board
• Oliver Munn – Director General, Health Protection Operations
• Hannah Taylor – Director, Policy

In attendance were:

• Will Welfare – Director, Regions
• 10 attendees had their names and titles redacted

Apologies:

• Dame Jennifer Dixon – Non-executive member
• Shona Arora – Director, Health Equity and Clinical Governance
• Scott McPherson – Director General, Strategy, Policy and Programmes

3. Welcome, apologies and declarations of interest

24/001 The Chair welcomed participants to the meeting, noted apologies, and confirmed that there were no declarations of interest.

4. Minutes of the previous meeting and actions

24/002 The Equalities, Ethics and Communities (EEC) Committee agreed the minutes of the 10 October 2023 meeting (enclosure EEC-24-001).

24/003 The EEC Committee noted that the three actions from the meeting on 10 October 2023 were in progress and that full updates would be provided at the next committee meeting on 30 April 2024 (enclosure EEC-24-002).

24/004 On action 23/095, the Chief Medical Adviser clarified that the paper on system level risks for the closed session of the Advisory Board would focus on health protection rather than the entirety of health service delivery.

5. Inclusion Health Update

24/005 The National Lead for Inclusion Health, the Public Health Consultant and the Deputy Director for Health Equity and Inclusion Health gave an update on UKHSA’s Inclusion Health workplan following endorsement of the ambition and scope by the EEC Committee in April 2023 (Enclosure EEC-24-003).

24/006 The EEC Committee noted the activities that had taken place to build the foundations for UKHSA’s Inclusion Health approach. These included:

• embedding inclusion health considerations across the agency by inputting into major programmes of work;
• raising the profile of UKHSA’s health inclusion work externally by participating in several high-profile events including the UKHSA Conference and the International Street Medicine Conference; and
• reviewing UKHSA’s surveillance reports to identify current reporting approaches to health equity and inclusion health and conducting a systematic review of other types of evidence to fill evidence gaps.

24/007 The EEC Committee noted the activities planned for 2023/24 to further embed inclusion health approaches across UKHSA and the health system. These included:

• reviewing evidence of effectiveness and cost effectiveness of different models of interventions;
• collaborating with system partners to provide insights for infectious disease services and exploring opportunities for data sharing;
• developing internal capability to support strategic improvements to inclusion health group data across the agency and with partners;
• developing guidelines and frameworks to provide infrastructure and direction for health services on health inclusion; and
• running a series of regional engagement events with system partners and communities with lived experience to influence system change.

24/008 The EEC Committee noted the limited availability of data on inclusion health groups. The review of UKHSA’s surveillance reports showed an inconsistency of inclusion health data across surveillance systems. Furthermore, interventions targeting inclusion health groups would be unlikely to result in a dramatic change in national statistics due to their small population size compared to the total population. Therefore, with the higher delivery costs of interventions targeting inclusion health populations versus the general population and given that any impact would be hard to quantify, the EEC Committee recommended that UKHSA clearly and consistently articulates the non-economic benefits of interventions on inclusion health groups.

24/009 There was further discussion on how to ensure that investments on health inclusion groups were having an impact given the limited availability of data. The Health Inclusion Team confirmed that it would measure changes to systems and service delivery overtime, and that for this they were exploring building a logic model in collaboration with the Science Group. The Committee noted that strategic improvements to inclusion health group data, such as using disproportionate sampling techniques, would be a longer-term endeavour.

24/010 In making strategic improvements to inclusion health group data, it was suggested that UKHSA disaggregates data as far as possible to identify underlying trends and patterns.  As an example, differentiating between migrants, asylum seekers and refugees; considering the intersectionality between inclusion health groups; and overlaying protected characteristics would promote understanding of nuances and therefore support the development of targeted interventions.

24/011 The EEC Committee endorsed plans to develop regional engagement series on inclusion health and broader health equity strategy. The regional engagement events would be a forum to enable health system partners to align around strategic priorities, share best practice, facilitate co-production of guidance and service design, and develop cross regional principles for engaging with inclusion health groups. The Committee recommended UKHSA focus on strengthening health equity structures and networks that were already in place rather than creating new structures and replicating.

24/012 To effectively collaborate across the inclusion health ecosystem, the EEC Committee recommended that UKHSA clearly demarcates its roles and responsibilities vis-à-vis system partners and focus resources where the agency can maximise impact. In was also suggested that UKHSA considers the diversity of partners in its work, particularly in developing cross regional principles for engaging with inclusion health groups. An example given was that Integrated Care Systems had different approaches to inclusion health.

24/013 An update on Inclusion Health to return to EEC Committee with a focus on outcomes of the regional engagement series and the development of the engagement framework.

6. Round table on equity challenge in the Social Care Sector

24/014 The National Lead for Adult Social Care and the Deputy Director for Health Equity and Inclusion Health introduced a discussion on the challenges to tackling inequalities in the social care sector and opportunities for improving access to high quality care (Enclosure EEC-24-004).

24/015There was discussion on the challenges facing the social care sector including significant workforce vacancies; high staff turnover; underpaid care workers; and unstable and non-recurrent funding. The decline in publicly funded social care was noted in the context of an increasing older and more diverse population with differing needs.

24/016 Discussion followed on what UKHSA’s role should be within the social care sector. It was noted that the social care sector was unlike the NHS in that it was fragmented with multiple stakeholders and funded differently. It was suggested that the agency was best placed to develop mechanisms for joined up working across the complex ecosystem. This should involve increasing understanding of the social care sector and supporting stakeholders to align behind common objectives and priorities. It was also suggested that UKHSA consider other care settings beyond residential homes including retirement villages, domiciliary care, and day services. The EEC Committee recommended that UKHSA clarify its remit vis-à-vis system partners and prioritise areas of work where its impact would be greatest.

24/017 The EEC Committee noted UKHSA’s objective of supporting the social care sector to ensure guidance is tailored to the differing risk profiles, outcomes and needs of populations receiving and providing adult social care. Guidance was frequently inaccessible and not suitable for all settings. The Committee recommended that UKHSA facilitates the segmentation of co-production of guidance with system partners including social care providers, people receiving care, and regulators and from the early stages of development.

24/018 The EEC Committee noted UKHSA’s objective to balance acute response with strategic developments. To enable strategic improvements in the social care sector, it was suggested that UKHSA focus on early intervention to prevent escalating health issues to reduce the use of health services, including emergency services and hospitals. This would require aligning health and social care and coordinating across entire care pathways from pre-diagnosis to end of life care. The EEC Committee recommended that UKHSA identify a couple of areas of initial focus on early intervention.

24/019 There was further discussion on the quality of care and it was noted that there was significant intelligence on providers that were under performing. It was suggested that UKHSA could facilitate the sharing of such intelligence across the system partners and facilitate the co-design of interventions. The EEC Committee endorsed UKHSA’s strategic engagement to improve the quality of social care and suggested collaborating with the Integrated Care Board network as a starting point.

24/020 An update on Adult Social Care to return to EEC Committee with specific areas identified where UKHSA can contribute and have an impact.

7. Forward look and topics for future meetings

24/021 The Equalities, Ethics and Communities Committee noted the Forward Look (Enclosure EEC-23-005) and suggested the following items as future topics:

• update on UKHSA’s Inclusion Health programme of work, with a focus on the Engagement Framework;
• update on Social Care Sector programme of work, with a focus on defining UKHSA’s role and responsibilities with system partners;
• responding to extreme weather events (e.g., flooding, winter planning) from an equity and communities’ perspective; and
• responding to climate change from an equity and communities’ perspective.

8. Any other business and close

24/022 The Deputy Director of National Health Security gave an update on scenario planning project to support Health Security Threat Assessment. This aims to develop 4-5 future worst case health scenarios over a 15–20-year time horizon to understand different health threats that might emerge, with health equity being key consideration, and will involve interviewing key people in UKHSA and the Department of Health and Social Care as well as partners from think tanks and academia.  The EEC Committee recommended that major government research funders should also be interviewed such as UK Research and Innovation, Medical Research Council, and the National Institute of Health and Care Research.

24/023 The Scenario Planning Project to return to the EEC committee with the final vignettes from equity and communities’ perspective.

24/024 Thanks were noted to all participants for their papers and contributions. The meeting closed at 15:50.