Health in All Policies: Leading place to tackle the wider determinants of health webinar, 15 September 2020

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Webinar recording

Webinar transcript

Louise Gittins: Good morning, everybody, and welcome to this very special webinar. My name's Louise Gittins. I'm leader of Cheshire West and Chester Council. The webinar is entitled Health in All Policies, Leading Place to tackle the Social Determinants of Health. We've got an hour and a half to discuss this important issue, and I'm pleased to say we've got five fantastic speakers.

We are expecting 200 people who've registered today to be attending, so hello everybody.

If people haven't been able to attend, we are recording today's session, so it will be available on the LGA website, as will all the slides that you'll see today.

So, just running through the order of events, we're going to hear from our speakers, and then at the end, there's a, a chance for everyone to ask questions.

So, if you've been on one of these before, or this is the first time, there's a Q and A function on your screen. Please submit your questions, queries, observations, comments, and everybody else can like them, and then they move up. So, the more likes that you've got, the more likely that your question or observation will be read out. And we'll do those at the end.

If you're on social media, Twitter, Facebook, or whatever, the Twitter hashtag is hashtag LGAHiAP. The coronavirus pandemic, and the subsequent measures to control the virus, have really shone a light on existing health inequalities many in our communities experience. People facing the greatest deprivation are experiencing a higher risk of exposure to COVID-19, and existing poor  health puts them at more risk of more severe outcomes if they contract the virus.

Local government leaders have been doing their utmost to support the most vulnerable to coronavirus, and keep all of their community safe during the pandemic.

However, we know that in the difficult days and months to come, we will need to do much more to tackle the deeper causes of health inequalities. So, we want to take this opportunity to build a fairer, healthier, happier society, by influencing the social determinants of health. This panel web, webinar will explore how local authorities across the country are leading this change by embedding a Health in All  Policies approach to their work. This webinar builds on our previous events on COVID-19 and ethnicity, and using Marmot principles to, to tackle health inequalities. It is part of our ongoing work in the LGA to support councils in
their commitment to ensuring that no one person in their community is left behind by the effects of this dreadful disease.

So, that's all from me, and let's get on to our speakers. And the first person I'd like to introduce is Alan Higgins. He's an LGA associate, and former Director of Public Health for Oldham Council. Alan, over to you.

ALAN HIGGINS: Thanks very much, Louise, and good morning everybody. I, I will tear that, that, that title, 'Former' something, which just kind of says, 'And he used to be important.' Anyway. So-, And what I'm going to do, I'm going to share my screen, so that you can see the slide set that I'll be using.

And I'll get that onto slideshow from the beginning. So, hopefully you can see that ≤it's the 'Health in All Policies,' and that we're here to launch the LGA's workbook. And what I’m going to do is, is talk about the concept of Health in All Policies through a few slides. And particularly pick up what it means to me, why it's important to me as a public health practitioner.

Then I’m going to switch into a, a different share screen-, And stick with me, the tech will work. Where I'm going to leaf through the workbook, just to pick out some highlights from it. Then I'm going to come back into my slide set, where I’m going to talk about work that I’m doing in my current role as, as Head of Programme for Public Health England, in Liverpool City Region, where I'm going to look at the Wealth and Wellbeing Programme that we've been implementing there for three years, and relate that to the Health in All Policies approach. 

So, so that's what I'll be covering in all of fifteen minutes, and then we can come back to questions at, at the end of the, the session. So, Health in All Policies. Strongly advocated by World Health Organisation and adopted worldwide. And it is. It, it's-, I've, I've seen approaches to Health in All Policies set out when I've been on a, a, a conference in New Orleans about five yearsago, where it was the American public health association, and they were talking about a Health in All Policies approach,
and had some significant guidance on it.

And it's across many areas in Europe, and in other parts of the world as well.

Originated in, in Finland, I think, they-, The concept was developed there, and this, this statement is from World Health Organisation Helsinki statement on HiAP in policies across sectors that systematically takes into account health implications of decisions, seeks synergies,' so joining up with other policies. 'Avoids harmful health impacts, in order to improve population health and health equity.' And for me, it, it's, it's about putting health at the top of the priority list, when we're looking at all of the policy decisions that happen through local government and beyond, and saying that what we need to achieve and prioritise and look at is how these different policies relate to health.

How they will help to achieve health and wellbeing, and what that means for economic policy, for environmental policy, for traffic policy, and, and, and so on, and transport policy. And that's why Health in All Policies is important to me.

It gets that health and wellbeing focus into each of these other policies, that don't necessarily have health as their,
their main reason for being.

This next slide picks out seven key benefits of a Health in All Policies approach. The first one here, 'Promoting health, equity, and sustainability.'

Equity, of course, is very much in the, the news since the impact of the pandemic, which has, has actually highlighted existing inequalities. Sustainability, very important to hear, particularly when we're hearing so much at the moment about threats to biodiversity, about climate heating. And I think that the link between promoting social, and, and health, and wellbeing, and environmental wellbeing, is a key one for us to, to address through a Health in All Policies approach.

Next four points, I, I'm gonna group together 'cause that's all about partnership working. It's about engaging stakeholders. And that's a key aspect of a Health in All Policies approach, is that you reach out beyond what might be the usual working partners, and you try to find others through a Health in All Policies approach. And the whole approach is geared to actually taking on board other perspectives, and then looking to see what the health impact of those perspectives actually are. The next point-, Is that the-, It's the sixth.

'Create structural or procedural change to embed tackling health inequalities.'

That's a, a key one as well, 'cause what we're saying is that with this Health in All Policies approach, what we're looking to achieve is long-term structural, procedural change. It's not a short-term, putting health at the top of the agenda for three, four, five, and six months, and then moving on to something else. It is about creating the structural or procedural change which sees the health and wellbeing as being the priority that we're looking all of the policies to actually address.

Final point there is about, 'Developing common monitoring and evaluation tools.' It's important we know whether we're having an impact. So, this next slide is, is one of my favourites. It, it comes from work that published in the BMJ in 2017 by Ben Barr and colleagues, a lead public health researcher from University of Liverpool.

And I'll, I'll just take a moment to explain what it is that we're looking at. So, up the side here we've got life expectancy, 70 to 85. And along the bottom we've got years from 1982 to 2016. And up this side, we've got the gap in life expectancy between-, The blue line is life expectancy in the 20 percent of the population living in those deprived local authorities. The green line is the population living in less deprived local authorities. And if you remember, policy from over the years is about how we close this gap between the blue line and the green line, going from '82 onwards to about 2016.

The red line, here, is a measure of how that gap is changing over that time. So, the red line is going up as the gap between these two lines is getting larger as well. So, you can see that the gap in life expectancy as a measure of health inequality is increasing throughout the '80s, throughout the '90s as well. And then during this period that's shaded here, which is when we had a national
health inequality strategy, you can see that the increase stops, and then it starts to come down. You can see the gap between these two lines is, is closing as well. Narrowing, at least.

And what I take from this is that during this period, when we had a structural approach to health inequalities, and this, this coincided with when I was a Director of Public Health in Greater Manchester, and we had a, a focus on those areas which particularly had large gaps in health, in, in life expectancy.

But when we had that structural approach, we-, When we had that focus for that period, we were actually able to have an impact. And that's what I'm wanting to send as the message through, through this work, and this presentation, is if the councils can actually have that structural approach which is sustained, you can, I think, have an impact on health inequalities. Otherwise it can seem as if it's something which is just there, and is always with us. But if you actually have that focus, you can make that, that difference.

So, now I'm going to change. So, back to-, Back to me for a moment, while I stop sharing those slides. And then I’m going to share the workbook.

So, what you can see on your screens now is the, the opening page of the, the workbook that we're launching today. And I'm going to assume that that's what you can see, unless anyone speaks up and tells me different. So, first point, I'll just leaf through a few bits of this. First of all, it is a workbook. It's got questions in here. It's got spaces for you to fill in your responses to those questions as well. And it is about a workbook to help councillors work through their, their understanding of Health in All Policies, and, and, and how that might be applied within their, their borough. I'm going to leaf down through a few pages here. This one, I'm going to make this a bit larger. This is the contents page.

So, we've got a, a, a, a recap of the Health in All Policies approach. Before that, we've got a summary of what the emerging key issues are. Then we've got this health section, 'cause this is about ,updating the health in all equalities workbook from the LGA to take account of COVID-19 and health inequalities. The impact of the virus and, and so on. And then, looking at the response of local government to COVID-19.

I'm going to highlight a few other parts, and here if you're familiar with LGA booklets, workbooks, you'll know that there's a good key here, which highlights the various things that might well be a challenge.

This is where you'll get questions asking you to think about how Health in All ≤Policies might be applicable in your, borough. Asking you to find out things about, say, the impact of COVID-19 on your borough as well.

I'll move on to page six, which is this part, where we have the emerging key issues for leading members. And I'll just highlight a few things here. Nature of the COVID-19 emergency and long-term implications. And the balance between immediate response to the pandemic COVID-19, to recovery, and about building a better new position. So, that is about just saying that immediate emergency
response is different from what you might think about a recovery plan, and then what you might think about where you want to ≤get to, building this new position.

And there's a section here about the unequal impact of the virus, and how-, And the response to it. And that's-, This section is summarising what is then explored in more detail as we go further through the, the, the booklet, the workbook. Here's one of the challenges.

So, it sets out a question, and then asks you to fill it in, if you're a councillor working in a particular area, what your response to that would be. I'm going to move down to page eleven, because of course, case studies are key when we're looking at trying to, to, to make something very practical, to make a very practical understanding of Health in All Policies.

And throughout the booklet, and throughout this presentation this morning, we'll be hearing from councillors who have been
applying this approach within their boroughs. So, there's something about Southwark. There's something further on about Newcastle, and, and so on. So, the booklet, the workbook, does have these, these case studies within it.

And I'll move down to page fifteen, just to highlight, this is the part where we've picked up COVID-19 and health inequalities. Impact of the virus. And moving further down, section talking about-, Well, there's a challenge. What has been the impact of COVID-19 in your borough, in your council? Response of local government.

There's an interesting section here about the new normal, and what it would be like functioning in a COVID-19 present world. So, that's kind of saying, 'Well, we talk about COVID-19
present 'cause we think there's a probability that COVID-19 will always be here.' Perhaps a bit like flu returning each year. And that we need to take account of what that might mean for us too.

So, so, that's what in the, the, the, theworkbook, and tha t's the, the point of, of what we're looking to, to launch today. I'm going to stop sharing that, and then I'm going to share with a final few slides to talk about the work that we have been doing in Liverpool City Region. So, if I can get this right. Current slide. There we go.

So, Liverpool City Region Wealth and Wellbeing Programme, where I've been working for three years. What we've done in that time, it has been looking at Wealth and Wellbeing. So, work and health, and economics and health. And some of the, the work that we've done, we, we, we'd linked poor health to the productivity gap  in, in the Liverpool City Region, so we could explain about a third of the productivity gap between Liverpool City Region and the rest of the country was attributable to, to ill health, particularly mental health. We, 'Engaged widely with the public sector, voluntary sector, and communities on economics and health. Built an evidence base. Created a narrative based on views of people unable to work through ill health, and proposed a plan focused on, on three points. 

Employment support programmes, reform to the workplace, and wellbeing economics.'

Why this is relevant to Health in All Policies is that it's-, It's this part here about engaging widely, drawing in, different perspectives. It's also this part about looking at economic policy, and drawing out the health implications of ≤economic policy. And then, what we're ,looking to do is to develop that further, to say how we could actually change economic policy to have a particular focus on, on wellbeing.

So, it's not an explicit Health in All, Policies approach, but Health in All mPolicies is going throughout this, this work. Next slide, just to, to add a bit of colour to the presentation as well, I wouldn't want to overstate this, but we, we did go out of our way to connect with new perspectives through this work, and continue to do so.

So, the system connection workshops is, is something I will keep coming back to, and again, for me, that fits with the Health in All Policies approach, that part about engaging, reaching out, finding new stakeholders, drawing more people in to the consideration of health and wellbeing as a priority issue.

And then the last slide, just the key message that has come out from that work so far, highlighted in yellow. 'An economy that functions effectively for everyone is better for health and wellbeing, and a population with better health and wellbeing is better for an effective and fair economy.' And that may well sound like a, a truism. I mean, who would-, Who would disagree with that? But what we're doing through this work is saying that that needs to be taken on board, thought about, and then we need to look at how that might well change our approach to economic planning.

Where we're looking to, to, to take this work forward in the next few months, 'Developing a joint approach, approach to reform of
economic planning, combines and prioritises environmental, social, and health outcomes with inclusivity. Sharing and networking across combined authorities.' And then, 'Recording our experience.' And it's this bit here which particularly relates back to Health in All Policies. It's about looking at the policy on economic planning, but drawing out the, ≤the, the priorities around health and wellbeing outcomes for that economic policy.

So, I'll stop sharing at that point, and just sum up by saying, it's about launch of the workbook. The workbook has some challenges within that that  should help you to apply a Health in All Policies approach within your borough, at least understand how you would go about doing that, and emphasises that we're looking for structural and procedural change that is then sustained over the longer term. And I'll finish there, and happy to come back to answer and respond to questions later on. Thanks very much.

MODERATOR: Thank you very much, Alan. That was really informative, and I’m looking forward to working through the workbook
myself. So, could I now hand over to Cllr Tim Hutchings, who is Cabinet Member for Public Health and Prevention at Hertfordshire County Council. Tim, over to you.

Tim, you're on mute. If you'd like to unmute yourself, sorry.


Is that okay? We're having all sorts of technical problems this morning, but it's lovely to talk. I don't know how to unmute myself, because of-, Good morning. A pleasure. Thank you all for the invitation to speak today. When the invitation came through, I have to say I was delighted, but a little questioning as to whether you had got the right person. I've been a Cabinet Member for Public Health and ,Prevention in Hertfordshire since January role, I knew nothing about public health. know a little bit more. I tell you this
not to highlight my own shortcomings, but to emphasise the need to get the message out there loudly and clearly that the health factor is a vital ingredient in developing our residents' wellbeing.

From that, I hope you will recognise that I’m very much a convert, and I hope to, to briefly make the case for Health in All Policies. For almost 20 years before becoming a cabinet member-,

MODERATOR: Tim? We are struggling a little bit with your sound, there. It's not coming through very clear. So, what I thought we could do is if we move on to the next speaker, and then come back to you, if you can have a, ≤a bit of fiddle round, and perhaps speak to one of our team to see what we can do to, to improve it. Is that okay? 'Cause ≤it's just really quite distorted. Okay.

So, if we can move on to our next two speakers, which is Grant Taylor, who is the Head of Culture and Health, and Cllr Andrew Gordon, Health and Wellbeing Partnership Chair from Basildon Council.

Thank you.

GRANT TAYLOR: Thank you, Cllr.

And thank you everyone for letting us speak today. I'm going to do-, I'm going to use the immortal words, 'I'm going to share my screen,' and then I'm gonna look ≤for assertive nods that it's working. Can, can people see my screen? Excellent.

So, bit of a double act today between myself and Cllr Gordon. We are both here from Basildon Council in Essex, and we're gonna
speak you through some of the work that we've been doing as an organisation, in relation to this important work.

So, yeah. Just to start off with, so I'm Grant Taylor. I'm the Head of Culture and Health at Basildon Council, and Cllr Gordon, do you just want to give a quick, hello to start off with?

CLLR ANDREW GORDON: Yes. I'm Cllr Andrew Gordon, and I'm Vice Chair for Health, Housing, and Communities, and Chair of the Health Board in Basildon. And it's a really pleasure to be here today, and speak to everyone.

GRANT TAYLOR: Thank you. Okay. So, our presentation today with-, Oh, I tell you what I should be doing, is I should be putting that onto slideshow, shouldn't I?

Apologies, everyone.

From the beginning.

There we go.

'Cause we're gonna be talking about something that we have been calling the Health Lens, which hopefully will make sense as we-, As we manoeuvre through the presentation, but in essence, sets out kind of how we try to take-, Put health-, The lens of health on many of the decisions that we make. So, I'm going to start off by just setting our, I guess-, What is the vision and the priorities under our health and wellbeing policy and strategy.

So, obviously our-, Without reading piecemeal here, you'll see our, our wider vision to enable the residents to live long, healthy, independent, and happy and active lives, with a series of priorities.

And I think importantly, for today's presentation, to point out where we are with priority number two, which looks at improving mental health and wellbeing. So, all of the priorities are interlinked, and as important as each other. But I know that one of the things that we were asked to talk about today following us being used in a case study for essential mental health in the LGA paper recently was in relation to, to mental health.

So, Cllr Gordon, I'll pass over to you for these next few slides.

CLLR ANDREW GORDON: Yeah. So, I mean, we could spend hours talking about government structures in local government.

I think the important thing is, is Basildon is not-, We don't have a statutory health-, We're not the statutory health authority. We're a district council.

I think over the last five or six years, we've really changed our view, that even though we don't have a statutory duty for health, health is absolutely essential to every single service that we run. A little sort of anecdote is a few weeks ago in our health board, where we was discussing COVID-19, was discussing some of the impact of COVID-19, an officer with responsibility for waste
and recycling came and spoke to us and said, you know, 'We're noting an increase in the amount of glass bottles being, you know, put out. What's going on with that?

You know, it's going up by 30 percent.

What are we gonna do? Are people drinking more?'

You know, so it affects every part of our business, from waste and recycling, to housing, to environmental health, it, it, it, it, it comes into everything we do.

It's a core part of our business.

Just moving on. In terms of why I think-, And I'm maybe gonna be a bit contentious, here. I think actually district councils
are better placed to look at and address some of the social determinants of health.

If you think about it, and you think in terms of the opportunities-, Grant, could you just move on to the next slide?

You know, district councils tend to be closer to the community. They tend to have local-, That local intelligence, that local insight into what's happening on the ground level.

You know, we're the ones that engage, often. We're the ones that are there with those connections. And I think that's been the most important thing for us in Basildon, is building those connections, and looking through it all in a health lens. So, even though there is complexity to having that two tier governance, I think for, for me, as, as, as, as the, the lead member on this, I see so much opportunity in us being a district council, and tackling this, this health and wellbeing agenda. And I think, if I think about our health journey in Basildon, and if, you know-, Grant, if you just move on to the next slide.

And I think about, sort of, where we've come from, I think for me I became a councillor in 2011, and, you know, not a public
health expert. Not, sort of, a health expert by any means. But one of the key things that, that I did as a councillor, every single meeting I went to, I said, 'What are we doing about health? How does health affect this?'

In fact, often I would challenge myself to go to a meeting where it was completely unrelated to health and wellbeing, and say, 'Well, what are we doing about health?' And over the years, officers in-, Within the council got to know that Cllr Gordon's gonna come
along to a meeting, and he's gonna talk and ask us about health and wellbeing.  It's-, You know, we talk about structures, but I think, you know, looking at health, and looking at the social determinants of ≤health, it's almost a culture change that needs to happen, because it's not just a, a, a, a process.

It's a mindset. It's thinking about health. It's thinking about how the decisions we make as a local authority are gonna impact on people's health and wellbeing. And that's absolutely crucial.

One of the things that was really helpful for us actually, and again, Grant, I'm not sure we're on the next slide. If you could just move on.


CLLR ANDREW GORDON: Was when we appointed a public health practitioner in 2016.

You know, having an officer in a district ,council that had that portfolio was absolutely crucial to us.

When we got, you know-, We got the sort of strategic buy-in, we got our health and wellbeing policy released, you know, that
was a massive achievement, really sort of set the groundwork for things to come. We had a refresh of our local health and wellbeing partnership.

You know, thinking about what partners we had around the table, not just the usual suspect, but actually, 'Let's invite the police along. Let's invite the youth service along. Let's invite social care ≤along. Let's invite, you know, care providers along. Let's make sure people around the table are not just typical people we go to to talk about health.

You know, let's engage with taxi drivers. Let's engage with barbershops.' You know, that's what we want to do. That's, that's,
that's our approach. It's about engaging the community, engaging the people that are on the ground. And that's not necessarily the local hospital. That's not necessarily the local CCG. And-, So, refreshing our health board, and refreshing what we did in Basildon, and our sort of strategic aims was quite key.

And then, one of the biggest achievements for me, thinking about what we did in Basildon, was actually getting health  and wellbeing, or a commitment to improve health and wellbeing, in our corporate plan. A brave move, because we don't have
a statutory responsibility for health and wellbeing. Actually, we as councillors, you know, said, 'No. No.' This is something we wanted to take forward, because it's so important. It affects every part of our business.

And having right up there in our corporate plan, I think, helped members, when they were-, When they were lobbying partners. It helped officers.

It was just the right thing to do. So, you know, if you-, If you take away, sort of, anything from this presentation, and you're a district council, check your corporate plan. If you've got a commitment in there to improve health and wellbeing, to look at the social determinant, have Health in All Policies, because it's crucial. It's absolutely crucial. And as you can see there, we're still moving on, and on, and on, in our health journey. And, you know, hopefully we're gonna be going from strength to strength. Grant, over to you.

GRANT TAYLOR: Thank you, Cllr.

So, what I wanted to give you are just perhaps some examples here, at a Tier 2 level. So, taking that perspective as to perhaps how we are working in a different space, and very much aligned through our colleagues at county, of course, as to kind of how we're looking at implementing that health lens, that health in all-, Throughout our services. So, I wanted just to give-, I won't go through every one of these, but I just want to give some examples here, really, as to some of the work that we're doing in this-, In this space. I mean, so as part of our Health in All Policies approach, Basildon Council is aiming to shift perspectives, so to all of its functions, whether that's litter collection, or it's facility management, it's leisure green space development. I'm ≤quite clear with all my staff that they, they do public health work.

They do public health at-, To, to, to some degree, or, or, or, or, or further, providing the places and spaces where people meet, and feel safe, and want to stay active, and want to-, Want to participate in their community. So, that's a really, really kind of key  perspective that we try to put on, on, on our workforce. And I wanted to share, I guess, a few examples, I guess, where we've kind of gone-, We've put that health lens on things.

So, straight away, looking at, sort of, what we done with our staff, so this model here around human resources.

We've been working recently very much in-, I'm sure many people will recognise this.

With the lockdown procedures, what we've seen is that huge elements of our staff have become very sedentary, where once upon a time, they were actively travelling to the station, and from the station to work, and, and would pop out on lunch break where we are, you know-, Like many councils, we're based in a-, In a, a town centre, where you pop out for lunch, and go and grab a coffee for a one-to-one, and all of the, kind of the good stuff. Well, people are-, Tend to be rolling out of bed, and sitting at their computer, and losing scope of when the day starts, and when the day ends, and, and certainly have lost a lot of their activity, which of course has huge impacts on people's mental health.

So, we started to work with an organisation called Street Tag, and Street Tag uses gamification to, ≤to create teams, to get out on the street, to walk, to run, to cycle, and, and to win points, over, over a three-month board. That first leaderboard has just finished across the community, not only for our staff.

Across their community. We have over 20 million steps over a three-month period of people participating. But we've been ≤really keen to see how we can incentivise people to get up and move around during the day, take a break from the computer.

Look after their eyesight. Look after their musculo-skeletal condition, etc. So, we've started to approach this where people can pick certain times in the day to earn treble points to get out there, go walk-, Go for a walk around the block, etc. So, that's one of the ways in which ≤we kind of tried to put our lens on how we're trying to support our staff. But that-, But that also aligns to our communities and partners. And a number of our community health partners have, have joined Street Tag, and have created teams as well, where they're competing with each other, and, and their members, which is quite exciting. Cllr Gordon also spoke a moment ago about, about waste collection.

So, we've noticed, and it was brought to the health and wellbeing board, the fact that we were seeing huge, record numbers of, of, of, of glass collection, and lots of those were beer, and wine bottles, and spirit bottles. So,  being a council that wants to take a, an
active health lens, and wanted to notice, those reports were coming back to our health and wellbeing partnerships, saying, 'You know what, our refuse guys are collecting incredible numbers of, of, of, of glass recycling. It's gone up over 50 percent.' So, that enabled us to have conversations with, with our-, With our core health team, to talk about what support we can get through our GPs, and through the services, in relation to people-, And just generally asking ≤questions around, around people's alcohol consumption.

So, really, really important ways of where you can find insight, and, and, and data, to be able to build a bigger picture. And the final one I wanna pick up on this slide was just some of our procurement work. Again, we've moved to-, From a situation where we're only procuring on who can provide us the most money, which in-, Let's be clear, in ≤today's day and age, is very important.

To, what are the outcomes we want to achieve? So, we're very much outcomes-focused.

So, we've done some really positive work with some empty community space in our community-, Sorry, in our country parks, where we're looking at procuring on the basis of our corporate plan, specifically looking around at the difference that people can make by using our facilities around health and wellbeing. And from that, we have created-, Well, we, we managed to engage a series of local charities that are working to support our residents around mental health, and around physical disabilities, and the like, to be
based on our community halls, and, and to be based in our community facilities more.

So, they are now weighted to being-, Having greater opportunities to-, And therefore supporting our local voluntary groups. So, there's others, but those are some of the examples we wanted to share of how we've kind of looked at things. A, a very holistic route to improving health for our services.

And then I want to talk about some health through our partnership working. So, I'll give you some examples here of, of some of
the-, Some of the partners that we are working with as, as well, and it's very much looking at how we can work with our community partners. So, BASIS, our sight impairment charity in Basildon, we've been working with those guys-, We've provided a public health grant to them. But part of that, what we tend to find was happening for our health and wellbeing partnership is that the grant was very transactional. We gave a grant, they said they were going to do something.

In a year, we said to them, 'Send us a piece of paperwork to say whether you've done it.' And that was great. But what, ≤what, what, actually, did we learn as a-, As a partnership? And often what came back was, the, the small micro-funding, actually, they felt quite isolated with it. So, whenever we're giving out small amounts of money, what we also are giving out through our grants is quite large, in-kind support.

So, we've created a buddy system with, with, with senior members of the health and wellbeing partnership, by, whereby we give micro grants, but also, you've got a buddy from within the group all year long. That group-, That buddy will go along and have a cup of tea, meet with the participants (ph 35.39), speak with them, try to kind of work out where we can feed them into the system, where we can-, Where we can help overcome, perhaps, some of their systemic issues with, with, with being able to provide the support that they needed. And from that also, it gives us a chance for them to come in as almost providing-, Welcoming their communities as experts by experience. So, from this sight impairment charity, they've been into our, our leisure facilities, into our customer service centres, and given our staff real insight on what it's like to, to work with-, To be someone with a sight impairment coming in to their facility, and how they can perhaps act better, and, and for us be, an, a, a better place. So, some really positive examples there.

We've been working with a fantastic organisation for many years called Sport For Confidence. Sport For Confidence are a group of-, Are, are run by OTs, and they are OTs that use occupational therapy to build physical activity into all that they do. And since we've built our, our sporting village, which is our major leisure provision in, in our town, we've had Sport For Confidence there running from the beginning. Now, what's interesting about that is Sport For Confidence are not a hirer. They are a-, They are a CIC, but they're paid for by our leisure operators, who are in the private sector. We have a relationship with the-, With, with our leisure operators on a profit share, but what's been really clear is we're not interested in profit share for this. We're interested in the outcomes it's gonna deliver. So, what we've got here is a-, The voluntary sector working with the private sector, and working with the statutory sector, or, or working with the, the public sector, I should say, to provide OT support in our leisure centres. Which basically means that where possible people are, are leaving a disability at the door, or unable to participate, not necessarily in stand-alone-, Our programmes for people with disabilities, but actually in, in the mainstream wherever possible, working with the OTs. And that has seen huge rises in the understanding, and the, the upskilling of staff, across that-, Across that leisure contract. So, we're really excited about that.

The final point I wanted to make on this slide was in relation to an organisation called Motivated Minds. Motivated Minds bring health and wellbeing, and specifically mental health support, to the high street. They're based in our major shopping centre, where we have large footfall, and they provide all sorts of kinds of service to the local community, whether that's classes, whether that's counselling, whether that's support. Or whether it's even just providing services for, for those with dementia, so as families and carers can go out and do the shopping that they need to do. Now, what we have done there, although this is running and a private sector operator, we have committed to providing zero percent business rates to them, because they are helping us meet our corporate plans around health and wellbeing. So, again, it's just another example around how we can even look at business rates, and our Revs and Bens teams to be able to drive the health impact we want to do. And that's, that's the example of the health lens.

So, I'll just whizz through this, 'cause I'm aware we're coming up to time. Clearly, what I've talked a lot about, what we're doing here-, But I really cannot pass this opportunity without sharing the incredible work that happens in our communities as well. And throughout the COVID-19 response, and, and wider, we have seen communities doing incredible work. And our, our role very much again, through our lens, is to-, How do we better enable to, to do that? Give them what they need, provide the support, but also get out of the way where, where we need to. 'Cause the communities have been incredible at stepping up, with regards to supporting each other with access to food and medicines, and, and befriending, and all the things that, that I know that all of the authorities here are doing. But I thought it was very important to make it clear that, when we talk about the partnership, this is very much in line with our communities, also.

Now, we're very ambitious in Basildon, too. So, we are very lucky that we-, There are two major investment opportunities that are through the, the, the larger infrastructure, and, and overarching bodies for sport and for art. The ELDP, which is the Sport England's funding for helping the most inactive get more active in deprived communities, as well as Arts Council's Creative People and Places, which again, looks at those that are most inactive, but perhaps culturally inactive. So, Basildon, I'm really proud, proud to say, are pilot areas for both, which has enabled-, And, and we've done that very much through looking at our health and wellbeing programme, and how we can use that community and physical activity work through Sport England, and that cultural democracy work through the Arts Council, to bring people on board, get them participating in their communities, whether culturally or physically. And, and we know that people that are happier, healthier, and more active, and with better mental health, if they live in a place they like to live, and that-, And are proud. So, that civic pride thing's really important. So, we're really grateful and really proud that we've managed to, to bring in many millions of pounds over the last couple of years to be pilot areas for the Arts Council and for Sport England, and our task now very much is how we align these pieces of work. And we've had a restructure within our organisation generally, so that we are best placed to do that. Aligning our leisure with our community work, with our-, With our-, With our cultural offer, with our public health work. So, under our culture and health team, which I'm very proud to, to lead.

So, what you'll have seen here, in these slides, is that we talked here about how we had health through our services, health through our partnership working, health through our national programmes, and health through our community activism. And in essence, what that means is we try to take a, a health in all matters approach, wherever possible. And that is what, I guess, we refer to as our health lens. Hang on. Change. Doing that thing. Oh no, here we go.

So, very, very quickly at the end here, looking forward. We're in the process, now, of creating our Connected Communities strategy. So, how do we take that great work that was happening in our communities and ensure that it, it wasn't something that just happened during COVID-19, and was, you know-, It was a stand-alone. We need to make sure that this is-, It, it-, This is standardised, now. We're looking at collating all of the various micro-funding opportunities, and creating a triage process, so we can see how we can take funding much further, and help meet the health and wellbeing needs of our communities. We are in the process of developing a social value policy, as well, actually, as a financial resilience, as well, policy, because we-, These are so important. And then Cllr Gordon, I, I will let you take over for this, this last point, here.

Cllr Andrew Gordon:  Yeah, just to-, just to finish. I mean, for me, the, the, you know, the most exciting thing-, We've got something going to committee tonight where we're hoping to-, well, we're putting together money from a footballer, Mark Noble, who's very kindly donated his money, Countryside Properties, and the county council are putting together a fund to improve mental health and wellbeing in our community.

That's just an example of how by working in a different way, by promoting health and wellbeing, by talking about health in district council, we can actually deliver them some real change for our residents. And it's very exciting. And I want to extend an invite. Anyone on this panel. If you're interested in the work that we're doing, if you wanna have a chat, please just get in touch. We're really happy, happy to speak to you, and thank you very much for inviting us here today.

Grant Taylor:  Thank you, everyone. Thank you so much.

Moderator:  Thank you. Have you come on to me yet? Hi. Thank, thank you. That was really interesting, and I've been scribbling lots of notes to take back to our health and wellbeing board, so that was fantastic. Thank you very much. Okay. So, we're going to try and go back to Cllr Tim Hutchings now, from Hertfordshire Council. So, Tim, if you'd like to have a go, and hopefully, fingers crossed, your technology's working now.

Cllr Tim Hutchings:  Thank you, Louise. Is that any better? Oh, good. Right, good morning. As I say, firstly, thank you for the invitation today. I have to say, when the invitation came through, I was delighted, but a little questioning as to whether you'd got the right person. I've been Cabinet Member for Public Health and in Prevention in Hertfordshire since January nine-, 2019, and confess that when I took on the role, I knew nothing about public health. 20-odd minutes-, 20-odd months later, maybe I can claim to know a little bit more than I did in the first place. I say this not to highlight my own shortcomings, but to emphasise the need for getting the message out there loudly and clearly that health factors are vital ingredients in developing our residents' wellbeing. From that, I hope you will recognise that I’m very much a convert, and hope to make the case briefly for Health in All Policies. As a former deputy leader of a borough council, and Cabinet Member for Environmental Affairs, a deputy Cabinet Member for Education and Libraries at county level, I think I can claim to have understood how things worked, but in an environment where delivering savings and efficiencies was important, I, I like many others, I suspect, gave little thought to the underlying immediate impact beyond those of the decisions I was making.

Having taken on the role, I was rapidly made aware of the fact that everything we as local authorities do impacts on health, the health and well-being of our residents. Whether it be through planning, education, the provision of recreational act, facilities, highways or the multiplicity of other activities. The decisions we make impact in one way or another on the health and well-being of all our residents. On taking up my post, the first thing I had to do was to complete the development of our prevention policy which thankfully, bar a few tweaks, had already been drafted.

The essential messages in that policy are, the importance of consider the health implications when making decisions. Collaboration, focus on inequalities and of course ensuring that decisions are evidence based, whilst of course acknowledging the need to ensure value for money. The importance of considering health implications and our decisions may appear to be self evident but I'm not sure everyone sees it that way.

I would argue that as we attach an equalities assessment on most policy and proposals these days, why aren't we also attaching a health impact assessment? Before coming on this morning, it seemed to me a good idea to check on the definition being applied to health in all policies and I, I apologise if someone has already done this, but I think it's important to go through it nonetheless. Health in all policies is an approach to policies that systematically and explicitly take into account the health implications of the decisions we make.

They target the key social determinants of health, they look for synergies between health and other core objectives and the work we do with partners. And tries to avoid causing harm with the aim of improving the health of the population and reducing inequity. I was particularly taken with a reference, 'And tries to do no harm.' Doesn't sound very ambitious does it? It is though, I would argue, an important point. The impact placed on health is important to us, as a council last year we passed a motion declaring an environmental emergency. And I'm pleased to say that our public health team is playing an active part in developing the strategies that are arising from it. We think that this is a clear example of an approach to policies that systematically and explicitly takes into account the health implications of the decision we and others make.

If one accepts the importance of place, and I do, it posed one key question, why is it necessary to include an assessment on health, sorry, beg your pardon. Why isn't it necessary to include an assessment on health and well-being of residents, when considering planning applications.

Unfortunately our planning health service has no statutory planning functions. It is not a statutory consultee in the planning process. This means there's no legal requirement for planning authorities to consult us, frankly I think that's a nonsense. It therefore follows that we have no statutory duty to respond to planning proposals or applications. Nonetheless, we at Hertfordshire feel it's important to do so.

In Hertfordshire we've put in place a strategy that states we will comment on all planning applications that are of a certain size where we have specific concerns. Clearly we can't engage on every planning application, so we focus on those we consider to be of sufficient size, scale or type of operation. Normally, if it's to do with housing, 100 dwellings and larger. The general guide is that we will look at all sizeable applications and may form an opinion where other factors come into play. For example, a small development for the elderly where the site is, in our view, will, when one of those are inappropriate.

As stated above, we have no powers but we do have influence and will recommend that health impact assessments are undertaken on all major plans, policies and development proposals. We'll also recommend that all plans, policies and development proposals have regard to our own planning, health and well-being guidance. If we consider it necessary, we will also consult independent experts such as the environmental scientist of public health England, to help inform, advise or provide external review of our conclusions and advice. As an example of, with regard to collaboration, as you will all know, a cost cutting requirement, sorry, I'll go back to that one. Collaboration as you will all know is a cross cutting requirement of any parts we're working through to be successful. That has perhaps been more evident in our efforts to tackle the current crisis. Apart from the operational benefits arising from it, I think it provides a good example of how effective consultation between stakeholders and partners can now, can add to the outcomes we all seek. There are many examples that I could talk about, but if I had to pick one, it would be our approach to dealing with outbreaks following the first wave. In developing policies with our ten district and borough colleagues, we have been able to agree a purpose in our efforts to protect the health and well-being of our residents.

Not something that you would think would be difficult under the current circumstances, but in doing so, we have effectively agreed a common approach, to share resources using the synergies between health and core objectives to the work we do with partners. I have always taken the view that public health there is plenty of work to go around, so it's better that we get on with delivery rather than wasting time arguing about who does what. To achieve this position, we have needed to work on developing a mutual cooperation and trust, which although from time to time has to get tested. Our work has been supported by the districts and boroughs in developing the initiatives, which for example has enabled them to introduce health hubs into each of their areas and has been extremely helpful. Over the past three years we have invested (audio distorts 51.09) in doing so. Each district has been allowed to tailor their hub, to meet their local need.

Moderator:  Tim, I'm sorry to interrupt but we've lost you again.

Tim, I'm really sorry, we've lost your, and it was so interesting. We've lost your audio again, so sorry, sorry about that, we're probably going to have to lead on, it was just in the last minute that it has just gone completely. So, really sorry about that. But it was great to hear, particularly about the stuff you're doing around planning, that's great. So, if I could now move on to Louise Marshall. Louise is a senior public health fellow for The Health Foundation. Thank you very much Louise.

Louise Marshall:  Thank you so much for inviting me. Now, it always makes me a bit nervous pressing this screen share screen button, hopefully this will work. Okay, slide show. Can you see my first slide? Great. Super, thank you so much for inviting me to speak today. I, I'm just going to work out how to move this on, I'm a senior fellow at The Health Foundation, so we are an independent charity, focused on health and health care for people in the UK. So, I work in the healthy lives team at The Health Foundation and our work looks beyond health care to the wider determinants of health, or social determinants of health. All of those things shape where and how we live, we learn, we work, we play.

So our aims in our healthy lives strategy is to change that conversation about health to focus on the role of health as an asset for society and the economy, rather than thinking about the burden of ill health, as so often dominates the narrative about health. And, through our work we promote policies and encourage local action to improve opportunities for health life in the UK for everyone. So, consideration of health and health and equalities across policies and actions of the different sectors. So, I've been asked to talk today about some of our recent work at The Health Foundation on health and equalities.

I'll first set some of the context that the COVID-19 pandemic landed in, but focus mainly on some of our works then over the past six months on the unequal impact of the pandemic on health. So, this slide shows, and it's a graphic we've produced about the wider determinants of health, or social determinants of health. And this infographic, together with more detail on each of those individual determinants is all available freely on our website at the link at the bottom.

Together with this quick guide introduction to the social determinants of health. So, all of these things in that diagram our work, our surroundings, our financial situation, our housing, education, what we eat, how we travel, who we live and socialise with, they all act together and interact to determine and drive our health in many different ways and differences therefore in each of these determinants drive the inequalities and health.

So, just to set the scene now, I will talk a bit about some of the health inequalities in the UK prior to the pandemic. So, this slide, which I'll talk through, it's quite similar to the slide that Alan showed earlier, but zoomed in on a slightly more recent period from 2001. It shows trends in life expectancy, depending on how deprived the area a person is born and lives in.

So, as we've heard, throughout the 20th century, the UK experienced some steady increases in life expectancy, but these improvements slowed and in some groups completely stalled over the past decade. So, these two charts, which are taken from the Marmot 10 years on report that we commissioned the Institute of Health Equity to undertake and which they published in February, just before the pandemic, shows this slow down in improvements since about 2010. So, see if I can put, yes about, at this point about 2010. So, the chart on the left is males and females, so very similar patterns, but both starkly illustrate those wide inequalities in life expectancy, where the top green lines in each chart represent males and females who are in the least deprived fifth of areas. And the grey lines at the bottom are those who are in the most deprived fifths.

So, the gap in life expectancy on average is around eight years and that's simply due to where a person is born and where they live. So, the slow down since about 2010 has brought no closing of that life expectancy gap and in some cases you can see there, I think particularly in women, this gap has widened over recent years. And if you live in a more deprived area, not only can you expect to live a shorter life, you can expect to live a greater proportion of your life in poor health.

So, these charts show healthy life expectancy, which is a measure of the number of years that a person can expect to live in good health. And it shows the lines at the top, so it's on the left as women, on the right as men, and the lines at the top, the blue lines, represent the least deprived tenth of areas, people in those areas. And the red lines at the bottom are the people in the most deprived tenth. And then along the bottom axis you can see on the left it's 2011-13 and then over to recent years up to 2018 and you can see that huge gap in healthy life expectancy has increased over that period and now stands at just about 19 years for women, and just over 18 for, for men. So, how ever often I show this chart it shocks me.

So the role of local government in addressing the wider determinants of health and therefore tackling some of these health inequalities is very clear. But as you're all too aware, local government budgets that are needed to do this have been subject to huge cuts in recent years and something we know is that these cuts have been greatest in the most deprived areas, so the very places where action on those wider determinants is most needed. We also know from some health foundation analysis we carried out on spending on children's services that in the context of these cuts, the pattern of spending has also changed.

So, a smaller proportion of total spend has been on preventive services, so in children's services that includes things like Sure Start and early years services. And these are services that we know can help tackle health inequalities and a greater share has been on more reactive services that has been responding to, you know, increasingly more acute needs. So, understanding that role of health as an asset for societies and economies and understanding that impact of all sectors on the health of the populations can support that case for action on a wider determinants. And as Cllr Gordon said, you know, recognising that health affects all of our, our business as well as all of the businesses, local government effecting health, can help make that case and we've heard some great examples so far of actions that that approach and that mindset has led to. So, moving on now to some of the unequal impacts of the pandemic. It's, it's really into that context then of increasing health inequalities and decreasing local government budgets that the COVID-19 pandemic hit us. And this was never going to be a great leveller. So, back in early May, at The Health Foundation, we published a piece setting out the ways in which we expected the pandemic could be a watershed moment for health inequalities.

And that without mitigating action and consideration of the really broad health impacts of both the virus and our response to the virus, the pandemic would certainly exacerbate pre existing inequalities in health, as well as introducing new ones. So since then over the last, sort of, six months we've been collecting evidence, doing some of our own analysis and also commissioning research on the unequal health impacts of the pandemic.

So, I don't have time in the remaining few minutes to go through all of the ways in which we know so far that the pandemic has unequally impacted health so far. But what I would like to share with you first is a framework that we have been using to help us think about this, which I hope you'll also find helpful and then I'll just go on to highlight a couple of the groups that emerging evidence tells us has been hardest hit so far. Sorry, I didn't realise this slide did this, there we go. I think it's all there, so thanks to my colleague, Tim (mw 01.00.30) for this slide, I'll take you through this, this framework first.

So, over on the left, the two grey arrows, we have these two enormous forces that have hit us, so the COVID-19 virus itself and we're sadly all too aware of the health impacts of this. And also on the left there is the government and societal response to the virus.

So, the significant measures that we've had to take that have disrupted pretty much every aspect of people's lives and involved as we know the shut down of significant parts of the economy. So, the two red circles over on the left there, they represent our starting points I guess. Where we came into the pandemic and our experience of the pandemic and the impact it has had on us, is strongly determined, not only by our prior health, so we know, as we've discussed, that's subject to huge inequalities. But also by our personal, social and economic circumstances, that includes our housing, our jobs, who we live with, where we live. In the middle then, we've got on the top the direct health impacts of COVID-19, so that's largely based on those things in the red circle. So, some people are more exposed to the virus, some people are more at risk of serious outcomes if they do catch the virus, some people are more at risk of direct mental health harm that we know is happening. And there are also the impacts of delayed or disrupted treatment for other pre-existing conditions. So, people may be presenting later, some services may have been paused as health systems deal with the pandemic. And then at the bottom there we've got the social and economic impacts of the pandemic, so many people have lost their jobs and or income.

Educational institutions and many industries were shut down, communities have been disrupted and the impacts of these things will be with us for many years to come. We know that health is impacted in a very long-term and by the social and economic factors and these impacts will strongly influence future health and health inequalities in our populations. So, I'm just going to go on now to speaking briefly about some of these unequal health impacts of the pandemic. So, firstly back to, to deaths and this chart shows excess deaths in the UK, which is the red line over the period of the pandemic, when it was at its peak in April in the middle there. And that's compared with the average of the previous five years which is represented by the grey line at zero percent there. So, while many of these excess deaths we knew, we know are due to the virus itself, not all can be attributed directly to COVID-19, so included in that, that line, may include deaths from disrupted treatments for other conditions, from also, some of the mental health impacts of the pandemic as well as any increases in other causes. And lots of work is underway to better understand what, what has driven that as well as the virus itself. But what we, we do know already is that not all groups have been equally effected, so this chart, it's all a bit small on there, but I'll talk through it briefly.

This is a chart from the Office of National Statistics that was released in late August, so it shows deaths, month by month, so we've got March, April, May, June, July along the bottom there. And the first two bars, so the middle blue bar and the yellow bar show all causes of deaths and in the blue bar that's in the most deprived groups. People living in the most deprived areas and the yellow bar is those in the least deprived areas. So, you can see between the blue and the yellow bar, there is, you know, huge inequality in deaths from all causes. The second two bars, the dark blue bar and the light turquoise bar, show deaths from COVID-19 in first the most deprived and then in, in the light blue the, the least deprived groups. So, you can see that there is also inequality in deaths from COVID-19, particularly apparent in April there which was really the, the peak of the pandemic and the peak of deaths in, in the UK. So, there has also rightly been a lot of focus on unequal health impacts of the pandemic on people from different ethnic groups. So, it became clear from the very early stages of the pandemic, this is a chart showing deaths up to the middle of April. That the risk of dying from COVID-19 was very different for different ethnic groups and risk being particularly high, as you can see here, for people of black and of Bangladeshi, or Pakistani ethnic groups.

Who are many times more likely than people, shown by this line here, of white ethic groups to die from the virus. So, there's a lot of research underway to really fully understand the reasons for all of this but it does reflect some of those pre-existing health and socioeconomic inequalities and likely, both a greater likelihood of catching the virus. Due, for example, to being a front line worker or living in densely populated areas or housing, but also worse outcomes if you catch the virus, including due to pre existing conditions. So, nearing the end now, just looking at some broader health impacts of the pandemic and this shows mental health. So, we know there's a very strong link between our economic circumstances and our health and there has been very alarming evidence about very immediate impacts on mental health. So, I want to really make two points from this chart, so firstly looking at the red bars. This shows the share of the population with poor mental health, so this is the adult population, by family income quantile. So, over on the left you have got the fifth of families with the lowest incomes, going as you move to the right of the chart those with the highest incomes. So, you can see that there is a gradient in poor mental health with more, higher prevalence of poor mental health, the lower the, the family income.

But then in the blue bars there is adults whose family financial situation has got worse during the pandemic due to potential loss of work and/or income over the period of the pandemic. And so this was in May, asking people to compare their mental health to pre-pandemic times. And you can see there that those people who have had worse financial situation due to the pandemic, or during the pandemic, have poorer mental health, across all income quantiles, but, you know, again, you can see that, that very clear gradient. So, those people who were worse off in terms of the mental health impact are those in the deprived areas and those whose situation has got worse during the pandemic. So, emerging evidence tells us that certain groups of the population have been more effected than others, financially, and so we expect some of the greatest health impacts to be seen in those groups. So, firstly some of the people who were on lowest incomes before the pandemic, have also been those who've been hardest hit financially, so often due to working in sectors that were shut down, such as hospitality and retail. We also know, again, for some of those same reasons that young people, especially those aged 18-24, are more likely than other ages to have lost work and/or income or been furloughed during the pandemic.

And then also we know that women are more likely than men to have taken on more caring responsibilities while schools were closed, often with a negative impact on their, their work or their income. For example, due, due to being furloughed or in some cases asking to be furloughed. So, just to finish off now, while evidence has been coming quite thick and fast and we've published monthly blogs over recent months that have rounded some of this evidence up, which are all on our website.

There's still a lot we don't know, much research is underway but much more is needed and next month we will be launching our COVID-19 impact inquiry. So, this inquiry aims to comprehensively synthesize evidence to date on the health and health inequality impacts of the pandemic. That will include how people's experience of the pandemic has been influenced, influenced by pre existing health and inequalities and also how the likely impact of actions taken in response to the pandemic have actually impacted health and inequalities. You can sign up, if you'd like to hear more about the inquiry and updates from the inquiry as it progresses, it's due to report next summer, at this link. And I will finish there, please do get in touch if you wish to and you can find our work on COVID-19, including the emerging evidence blogs collated on this page of our website. Thank you. Stop sharing my screen.

Moderator:  Thank you, Louise, there was some very startling and sobering facts that came out through that and I think it gives us an idea of the scale of the challenge that we have going ahead. And thank you to all our speakers, so now, we're over to the Q&A session and we've got the first three questions that we're going to ask. So, the first one and I'm going to ask either Andrew, Tim or Alan, because it's sort of a council related one. So, in your experience, what are the most effective ways of, of strengthening joint working with partners in the NHS? So, if one of the, Alan, Andrew or Tim want to come back, or all of you can.

Cllr Andrew Gordon:  Yeah, I mean, I mean it's something I feel very strongly about, because sometimes I just felt like banging my head against a brick wall when it comes to working with the NHS. You could literally have an open door and say, 'Come in this way, we can help you, with all your health problems, this is where you go.' Yeah, getting them around the table is a nightmare. I found I had to do two or three things to, to really, sort of, get them around the table. One, send letters, you know, from Cllr Gordon, saying come to our meeting, really lobby them hard and lobby the, you know, the Chief Executive of the CCG, the Chief Executive of the local health trusts. Y

ou know, that lobbying was key and meet with them if they don't attend. So, if, if, a, if a health care partner, or someone from the NHS is not attending a meeting that they need to be at to talk about some of these really important health and well-being issues, I will go and meet with them. And I'll say, 'Why didn't you come along to this meeting? You know, why wasn't you here? It was really important to have your voice at the table.' The third thing is making sure you're getting the right people around the table. The NHS is a massive, complex beast and you know, you have to gauge what person from the NHS needs to be at what meeting.

You know, if you're, if you're getting a, a front line nurse, her experience is going to be very different to a, a commissioner. So, working out where you, where you target, or who you target is just as important as targeting them in the first place. Sometimes I felt like it was a campaign, it was a campaigning issue that I, as a member, took up. And I also think there's a lot for our officer (mw 01.13.11) as well, but I'm not speaking too much about that because I don't have experience of that, but yeah. I think from my perspective as a member, that banging on the door, that sort of targeting, that sort of relentless campaign to get them round the table and open up those conversations, that, that's, that's, yeah, how I roll.

Moderator:  Thank you and agree with you Andrew, it's a long journey and we've been on it for quite a few years now and I think we've got to a really good place actually, so don't go, don't give up, keep on. Alan you've got your hand up.

Cllr Alan:  I have, I'm going to put my NHS hat on for this I suppose. Having been an NHS employee for 20 odd years, I'm very proud of all that time and working then in local government for half a dozen years was, it was a great experience and I'm very proud of that work too. That, and I certainly agree with what Andrew was saying, remember that the NHS is not one body. It, it's got so many partners, even within the NHS, so bear that in mind whenever you're, you're approaching the NHS. And I suppose the only thing I, I would add is that when I've been looking at partnership working, one of the things I keep in the back of my mind, is that you have to make everyone believe that they are a leader.

Whenever you're talking to them, and that they're leading on their own particular dimension of the work, and of course that is actually right. They are leading their own particular perspective and whatever that issue happens to be, it might not be the one that you particularly recognise. But I think some of the, the success in partnership working is recognising that everybody is leading to some extent on, on that area. And, so it is definitely worth doing, the rewards are not always immediate, but it's, it's worth persevering.

Moderator:  Good, that's coming out loud and strong, isn't it? Persevere. Tim, if your microphone's working, do you want to come back in on anything? Okay, I think we might have lost Tim, Louise do you want to comment at all? No, okay, that's great, so next question. How does health fit in with the local crime scrutiny panel, we call it a community safety partnership, but it's probably the same thing, or the violence reduction unit, to tackle risk factors for crime and disorder? That's quite a tricky question that, Alan or Andrew, I don't know if you can help with that? So, where does, where does health fit into the crime scrutiny panel, community safety partnership, whatever you're calling it locally?

Cllr Andrew Gordon:  I think the answer is quite short and sweet here, it fits in very well and it, it absolutely should be at the heart of any community safety partnership should be how they're tackling some of the health and social problems. In, in Basildon we invite the police along to our meetings, we invite our community safety team along, so there's that, that conversation. But, I don't think you can have, you can have that conversation around health if you don't include community safety. Yeah, it doesn't' make sense if you separate the two.

Moderator:  Okay, Alan do you want to add to that?

Cllr Alan:  Not much to add, that sounds like very good practice, I suppose, I would just add that health colleagues ought to, to know that that's an invitation they should take up. That we need to have that perspective from the health service, on, on crime support partnerships and violence reduction units. So, should that invitation come through, please take it, you know, set aside other priorities and do contribute to that work.

Cllr Andrew Gordon:  And the police tend to have a bit more money than us, so it's, it's always worth trying to tap them up, if you can find that angle. I hope there's no police crime commissioners in the room, or listening, because they might have a word to say, but yeah, definitely try your luck, definitely.

Moderator:  Louise, do you want to come in?

Louise Marshall:  Yes, so, to a lot of our work, we, we're very interested in systems approaches to the wider determinants of health. And you know, once you start to take that perspective of the system and think about how the determinants of crime, the impacts of crime, the determinants and impacts of health, sit together in that complex system. That, you know, really tells us that these things are so inextricably linked and, and can't be separated and thinking about how they interrelate is, is so important to, to the approach. And I think really engaging the breadth of sectors that need to act.

Moderator:  Thank you. Now there's a comment and this is, rather than a question and it's a bit of a, quite controversial maybe, but let's have a look at it. So, it says, 'Would be interested in how we frame health in all policies. How do we ensure that we don't continue to focus on lifestyle issues but rather the causes of the causes? Was reading some journals suggesting that dropping health might help the cause and focus on equity and equality and could be more successful. This may resonate with colleagues in councils.' So, I'll take, I'll start with Alan this time.

Cllr Alan:  Thank you. I saw that question, challenge, when it came in which is very interesting one. So, you'd be looking at equality and equality in all policies. I, I, it's up to you in your local situation to work out what's going to, to work best. If you stick with health in all policies, that has that multinational resonance, it has a history to it, which will bring some people into the discussion that perhaps starting out with a focus on equality and, and equality might turn them off. I don't know, you'd have to assess it locally.

The, what I've recognised in the challenge as well, that potential to drift into looking at lifestyle and behaviour and certainly that's something that we would want to avoid and that the health in all policies approach should be something that goes right away from that and gets into social determinants of health. The only way you, you'll keep a lid on that is to be conscious of what is happening. If it is drifting into lifestyle discussion or behaviour, then get it back on track. And my personal feeling is that, I, I wouldn't' go for that, that overall change in, in the, in the communication of the approach. I would stick with health in all policies, that has some resonance for me, you can bring in equality and equity under that heading still I think.

Moderator:  Thank you Alan and Andrew, anything else you want to add? And then I'll come onto Louise.

Cllr Andrew Gordon:  No, just to say very, very briefly, I think it's important to keep the health tag. Because I think, that, that is the vehicle to bring partners around the table and how you pitch that is the key thing. You know, whether, and you have to know your audience, you know, you've got to know your audience, if it's the police, it's community safety. If it's, you know, perhaps the, you know, the council's finance department. It's finance, you know, find your pitch, find your in and then sort of drive health straight through it. But you've got to find your pitch, you've got to find what angle works.

Moderator:  Thank you Andrew, Louise?

Louise Marshall:  So, again, a, a bit of a plug here but we've been working with a frameworks institute over the last couple of years on, on this very point really. You know, understanding what we as professionals need by the wider determinance and about health is not always the same as what everyone else thinks about, when they hear the world health and you know, we know that there's a very, sort of, individualistic and medical model in people's minds. About how they understand what, what's health and therefore, you know, what determines health.

So, it's research that's underway but there's, there's information on our website and I can share links if people would be interested. Really to help understand firstly, you know, how people are thinking about health, but also about how to reframe that conversation and how to talk about health in that way that doesn't take people immediately to those mental models of, you know, these sort of lifestyle behaviours and both words that we don't like. That, that immediately me to mind and individual responsibility but help them to think about and understand the wider determinants and the societal responsibility for health.

Moderator:  Thank you Louise, that's very helpful and I look forward to sharing the link so that everyone can access that information. So, Louise this is a question for you, why are people from BAME population disproportionately effected compared to others and what are the underlying reasons?

Louise Marshall:  So, huge question, there is a lot we don't know still and there is a lot of research underway to better understand that. But likely due to a number of reasons that are very linked and if you think back to that framework I put up, and those red circles that show our, sort of personal circumstances. So, our pre existing health and health inequalities and we know that people from black and Asian and minority ethnic communities are often more likely to have pre existing health and equality, health conditions. Which then pre-disposes them to more serious outcomes of the virus should they catch it.

There is also theories about where people work and their likelihood of being exposed and catching the virus in the first place. So that maybe through workplaces or being a front line worker, or working in a sector that continued throughout lockdown. So, potentially in, in healthcare or in other service industries. And also how much we come into contact with people in our day to day lives, so if we live in more crowded housing and we know some ethnic groups live in larger households or in more crowded housing and more likely therefore to be exposed. So, a range of interlinked factors that are very difficult to disentangle and, and act together, but yes, basically sort of how likely they are to be exposed and also how likely they are to have adverse health impacts due to pre existing health and socioeconomic inequalities that exist.

Moderator:  Okay, thank you very much Louise. One final question and it's a quite starter for ten. There's a question come in about neighbourhood policies and somebody has put, 'We are finding that many of our volunteers are no longer available because they've gone back to work and is this an issue in other authorities?' So, Andrew is that a challenge, we're facing that challenge.

Louise Marshall:  I think Grant, I think you'd be best placed to speak about this, because this is something that's your, you know.

Grant:  Yes, thank you, Cllr. The honest answer is yes, a perfect storm, obviously, happened a few months ago whereby lots of people had more time on their hands and there was a national call, everyone's moment to step forward and help out as a community and, and, and now, that clearly is lessening. What we have tried to do is to recognise that we're not going to be getting the same numbers of community volunteers, but then to perhaps work with them to say, 'Okay then, now you've kind of got a bit of a, you've seen how you can help and the difference you make and it was a bit of a buzz out there. How actually can we retain you and in what way and, that could suit you?' So, we are very much looking, I mean, across Essex generally, but in Basildon as well, we work with the Lottery to help draw down funding from them to hugely enhance the volunteer centre that is run by our CBS. So, we brought in another £58,000 to, to do that, working with them, which was a real positive. And part of that was really about how we could digitalise the offer, so almost get more involved in micro volunteering, so people volunteering more on a one to one basis, with their communities, rather than volunteering for this one set offer, where we need you to fill this job description. Therefore if you can do that we want you and if you don't, we don't.

Which obviously is hugely important to the way the voluntary sector works in many ways. But what we tend to find is that most people are volunteering on their own terms and, and and actually was it volunteering, or was it actually just neighbourliness and that's perhaps where we want it to unlock more. Was just that, 'I'm going to go to the shops next door neighbour, do you need anything on the way, because I know that you're mobility is not great.' I'm not quite certain why a pandemic has led us to do that, but, but we're all human beings and so we've been trying to encourage that to happen more. I think I have a nervousness of a second lockdown and having lockdown fatigue, whether, and I think, so that is a concern and that was part of the reasons why we wanted to work with our, say our CVS to be able to build their capacity. We did rise, raise to the challenge with lots of our partners working together in what we call a community hub and we've not let that go. So, we're gonna continue to work in that way, but yes it is a concern. But I would say focus very much on the neighbourliness side of things. What you can do in the streets where you live. People very much galvanized around the streets and the areas they cared about. We talk, (mw 01.27.40) from local government, we're talking ward boundaries and borough boundaries.

Communities aren't talking like that, they don't really know what that it is, they don't really care how often, so focus on the areas that people really care about and look at their micro volunteering, they might, would be my, my advice. Thank you.

Moderator:  Thanks very much Grant, I'm afraid that's all we've got time for today, but maybe a future Webinar, a topic could be around volunteering, I don't know if that's something that the LGA have got planned. But I know it's an issue we're all facing and if we do go into a second lockdown, I think Grant's observations are correct and we may struggle to get people volunteering in the numbers that we had in the first time round. So, thank you all, those people that have attended, there's lots and lots of links for you. The Webinar will be available in 48 hours, as will the slides that everyone has been sharing. There will be a survey, as you get with all of these events, to see how we can improve it. So, thank you all, lovely to meet you virtually and stay safe, good bye.

Cllr Alan:  Thanks very much.

Cllr Andrew Gordon:  Thank you everyone, bye.

Louise Marshall:  Thank you. Bye, bye.

Grant:  Bye.