'It's listening to people' - radical new NHS plan to tackle growing issue of health inequality in Leeds
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‘Leeds will be a healthy and caring city for people of all ages, where people who are the poorest improve their health the fastest’.
That has been the ambition of health chiefs across the city for a number of years but the NHS Leeds CCG’s new framework for action has put in place a series of radical measures to help it achieve that aim and try to finally bring an end to what has been a growing scandal of health inequalities in the city.
As reported in yesterday’s Yorkshire Evening Post, the CCG’s plan aims to give more power and funding to community-level organisations to tackle the issues in their neighbourhoods, taking a more targeted approach as well as re-examining its own projects to ensure a focus on health inequality.
The framework also formally recognises the many factors which can leave someone facing poorer health outcomes.
One well-publicised factor is geography.
As the YEP reported yesterday, currently 220,557 Leeds residents - a shocking 26 per cent of the city’s total population - live in what has been recognised as the top ten per cent areas of deprivation nationally.
The latest count is also a 21 per cent rise on the 181,686 people in 2010.
Around 80 per cent of those in severe deprivation live in seven suburbs: Harehills, Chapeltown, Middleton, Burmantofts and Richmond Hill, Beeston, Seacroft and Armley.
Statistics also show that 28 per cent of preventable life years are lost for people living in these areas, with cancer, cardiovascular disease and respiratory still accounting for the most deaths.
Other known issues in these areas in terms of avoidable deaths are infections, the health of mothers and infants and neurological illnesses.
All of this adds to the grim statistic that life expectancy for men in the city’s most deprived areas is 11.5 years lower than those living in the least deprived. For women, the gap is 9.4 years, according to recent figures from Public Health England.
Tim Ryley, chief executive of NHS Leeds CCG, said Leeds has an “enormous” amount of people living in severe deprivation.
“People in Leeds who are living in these most deprived communities suffer poorest health outcomes.
"It's a really significant health issue. It also means that not only do those who are suffering in that way have a shorter life and a poorer quality of life but they also require considerable resources to be directed towards them almost inadvertently.”
Another issue in deprived communities is higher birth rates.
Tim said: “This can have really significant knock-on consequences if we don’t look to address it. [So] it’s not only about how do we manage the health of adults - we’re working with colleagues in the council to look to address the health and well-being of children.”
He describes how geography affected two members of his own family - both older men, one who grew up in a deprived area of Manchester and the other who was raised in a nice, leafy area of Somerset.
He said: “At 85, one was in a care home with dementia, arthritis, away from his wife. The other was driving to see friends in the south of France.”
Tim said anything which can be done to help address that stark imbalance “is a really significant thing to be doing”.
It's not just where someone lives, however, that has an impact on health.
The CCG’s framework also takes into account who someone is - their age, gender, disability, ethnicity, sexuality - and how people treat them, looking at stigmas and discrimination.
It seeks to highlight vulnerable and marginalised people who live in all areas of the city, deprived and affluent, who are also known to suffer from health inequality.
These include people from black and minority ethnic groups, Gypsies and travellers, the unemployed, looked after children, the homeless, sex workers, people with learning disabilities and people living with severe mental illness.
For Dr Lucy Chiddick, a GP and the CCG’s clinical lead for health inequalities, the fact that the new framework highlights these groups is a vital development.
She has spent many years specialising in helping these vulnerable groups, which traditionally sit on the edge of society but have significant health needs.
“It’s really important to articulate that. They face huge challenges and huge health inequalities and are massively disadvantaged compared to the rest of the population.”
She said, for example, the average life expectancy of someone who is homeless is between 40 and 45 years - far lower than those in the most deprived areas.
“It’s about looking at your city as a whole. Looking at the health inequalities across the city geographically - that does absolutely need to happen - but what also needs to happen in parallel to that is look at those vulnerable and marginalised groups suffering deep social exclusion and address their needs.”
Much of that, she says, involves "understanding the narrative" behind these people and the “impact of trauma and complexities of that in people’s lives and how that can underpin their life opportunities - it’s a complex minefield".
Dr Chiddick praised the CCG's plan for formally recognising and prioritising these groups in the health inequality framework.
"It's extremely innovative in its approach. I think it's absolutely the right thing to do.
"One of the aims of Leeds is to improve the health of the poorest the fastest and I feel with this framework we absolutely will achieve that and do it in an innovative and dynamic way - putting people's voices and needs at the heart of it. That's where we are starting from.
"It's listening to people, hearing their voices and responding to need."
She added: "I'm proud to work for a CCG which are demonstrably going out to reduce the health inequality of the system and in our city. I think it's just brilliant."
While acknowledging that the impact of Covid will create added complexities in addressing the city's health inequalities, Tim stressed he still has high hopes for the success of the framework.
"Because of Covid and the consequences of Covid in economic terms, we are in the position where the challenges are much more acute.
“What I hope, in terms of periods of austerity - which we are going into - is that the gap [between most and least deprived] doesn’t widen. We would like to think in five years that we wouldn’t have seen in widen further and probably see it narrow a bit.”
Tim said he was “very excited” about seeing the framework in action, adding: “The framework is a priority and it’s really a matter of putting it into action. We have agreed £355k [investment] in a few scheme that will take this forward and set out our stall this year.”
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