health

The disparities in housing and public health within the BAME community and the pandemic crisis

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Cllr. Ketan Sheth

Public Health is important: it prolongs life. A fundamental quality of Public Health is its preventative nature; prevention is far more effective and far less expensive than cure. Public Health is important because we are constantly striving to close the inequality gap between people and encourage equal opportunities for children, all ethnicities and genders. Health is a human right and we should be ensuring no one is disadvantaged, regardless of their background, their ethnicity or where they live. Becoming the voice for people who have no voice is our collective duty. Simply put, our influence on the improvement of someone’s health is a fundamental act of kindness.

Poor housing and living environments cause or contribute to many preventable diseases, such as respiratory, nervous system and cardiovascular diseases and cancer. An unsatisfactory home environment, with air and noise pollution, lack of green spaces, lack of personal space, poor ventilation and mobility options, all pose health risks, and in part have contributed to the spread of Covid-19. The disparities in housing and public health within the BAME community have persisted for decades cannot be doubted, and is underscored by a raft of research over the past six decades as well as highlighted by the recent analysis of the impact of Covid -19. The death rate among British black Africans and British Pakistanis from coronavirus in English hospitals is more than 2.5 times that of the white population.

What are the possible reasons? A third of all working-age Black Africans are employed in key worker roles, much more than the share of the White British population. Additionally Pakistani, Indian and Black African men are respectively 90%, 150% and 310% more likely to work in healthcare than white British men. While cultural practices and genetics have been mooted as possible explanations for the disparities, higher levels of social deprivation, particularly poor housing may be part of the cause, and that some ethnic groups look more likely than others to suffer economically from the lockdown.

Homelessness has grown in BAME communities, from 18% to 36% over the last two decades – double the presence of ethnic minorities in the population. BAME households are also far more likely to live in overcrowded, inadequate or fuel poor housing. What’s more, around a quarter of BAME households live in the oldest pre-1919 built homes. And their homes less often include safety features such as fire alarms, which is striking given the recent Grenfell Tower tragedy. Over-concentration of BAME households in the

neighbourhoods in London, linked to poor housing conditions and lower economic status all ensure negative impacts on health, all of which means lower life expectancy. The roll-out of Universal Credit is having greater effects on the living standards of BAME people since a larger percentage experience poverty, receive benefits and tax credits, and live in large families.
Larger household size also means that ethnic minorities are far more vulnerable to housing displacement because of the Bedroom Tax or subject to financial penalties if they do not move to a smaller home.
These stark facts, sharply bring to our attention the health, social and economic inequalities among our minority ethnic community, all of which are critical to understanding why some ethnic minority groups are bearing the brunt of Covid-19. In this time of reflection, it is not enough to observe; we must think about what more we can do, right now, to reduce the health, housing and economic vulnerabilities that our BAME communities are much more exposed to in these fragile times. Let’s act and prolong life together, as a flourishing community.

Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

The national political tremors have settled. Let’s re-focus on local health scrutiny

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Cllr. Ketan Sheth

There was a lot of national media commentary and coverage about the role of the NHS at the recent General Election, which was unsurprising given all the commitments major political parties were making: boosting NHS funding, more doctors and extra GP appointments, rebuilding hospitals, and so on.

However, I think that members of overview and scrutiny committees – of all political parties – know that the NHS in particular and health in general are always a major issue in their areas regardless, not just because of the casework we receive from constituents or because health and the NHS tend to fill up a lot of the space on the work plans of our scrutiny committees.

Firstly, local government is part and parcel of the structure of the NHS in many localities, with Directors of Public Health and Directors of Adult Social Care sitting on the executives of Clinical Commissioning Groups. And, let’s not forget that many elected councillors are involved outside the local authority in the governance structures at a Board level of many of their local NHS providers (I will declare an interest as I am a Lead Governor of Central and North West London NHS Foundation Trust). In local government, we have a view of the NHS from the root up and dare I say probably a more detailed picture than those operating at a national level or, to use today’s jargon, a ‘granular’ picture, which shows that every area has its own strengths and weaknesses that may or may not align to the national picture.

So, now we are settling back into the business of ordinary scrutiny committees there are three areas which, drawing on my own experiences, I think many healthy overview and scrutiny committees will be focusing on in 2020. They look a little different to the recent national debate.

Firstly, the quality of services, particularly of primary care, is a growing area of importance alongside access to services. The Care Quality Commission publishes ratings for each of the primary care providers in each area; it’s always worth keeping up to date with the local picture, in particular how ratings change. What you will want to see is an improvement in these ratings, and fewer GP providers being placed in special measures as a result of an inadequate CQC rating. If it’s heading in the opposite direction in your area, it might be time to ask why.

Secondly, working at scale is increasingly the big challenge for the NHS. On the commissioning side in north-west London there are plans to merge eight separate CCGs into one body by April 2021. That will mean a single operating model, and I assume some commissioning arrangements, operating at scale, commissioning services across many different boroughs. That’s something we will be tracking with care.

Finally, workforce is an issue which is frequently raised at health overview and scrutiny meetings. We’ve heard a lot about problems nationally of recruiting to specialist posts, as well as vacancy rates for nurses. But is it time to ask about the local pressures on recruitment and retention in the hospitals for the big provider trusts in your area?

So, now the national political tremors have settled let’s re-focus on local health scrutiny issues for 2020. Who knows, they may be very different to the national picture.

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Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. 

 

Can we commission for outcomes?

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Anniina Tirronen

‘Outcomes-based commissioning’ has become the dominant approach to commissioning services in the United Kingdom, with similar concepts such as value-based purchasing and payment by results being explored in the United States and Australia.  Instead of determining the volume or exact nature of services, outcomes-based commissioning focuses on desired ‘outcomes’, such as changes, healing or other effects that take place as a result of services, allowing producers and clients to shape the way targets are reached.  But what effect does commissioning for outcomes have, and is it a better way to commission services?

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‘Secret plans to close hospitals’: the perils of centralism

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Catherine Staite

The Kings Fund’s warning, that there are ‘secret plans’ to close hospitals, comes as no surprise to local government. A number of local authorities, including Birmingham City Council, Sutton and Camden have decided to publish the NHS’s ‘Sustainable Transformation Plan’ (STP) for their area, against the wishes of the NHS, because of concerns about lack of transparency and particularly the lack of engagement with communities about the best outcomes.

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