Agenda item

The Community Impact Assessment (CIA) explores how communities across Surrey have been affected by COVID-19, communities’ priorities for recovery, and what support these communities might need in the event of another outbreak. The findings of the research show that COVID-19 has had a disproportionate impact on some communities within Surrey and identifies a risk that inequality between communities is likely to increase. The Board are asked to consider how the findings can be incorporated into the Health and Wellbeing Strategy and used to inform decisions around future service delivery and resource allocation.

Siobhan Kennedy dropped out of the call at 2.52pm then re-joined at 2.58pm

Witnesses:

Dr Naheed Rana - Consultant - Intelligence and Insights (Public Health SCC)

Rachel Abbey - Advanced Public Health Information Analyst (SCC)

Ruth Hutchinson - Director of Public Health (SCC)

Satyam Bhagwanani - Head of Analytics and Insight (SCC)

Key points raised in the discussion:

1.   The Chairman noted that the Community impact Assessment (CIA) explored the impacts of Covid-19 on communities in Surrey and looked at social deprivation and health inequalities in different locations, communities and ethnic groups across Surrey, highlighting areas of need.

2.   The Consultant - Intelligence and Insights introduced the report, noting that provisional findings were reported to the Board as the data was still being synthesised - the Board would continue to be updated with further findings.

3.   She highlighted that the CIA was a result of the Board’s agreement in June to deliver a population health and intelligence response to understand the impact of Covid-19 on Surrey residents, supporting recovery.

4.   She noted that the (CIA) explored health, social and economic impacts of Covid-19 across Surrey and highlighted groups disproportionately affected helping partners to act preventatively by providing targeted support to communities to mitigate future impacts.

5.   It was hoped that the CIA would develop into the Joint Strategic Needs Assessment (JSNA) and would inform the Health and Wellbeing Strategy.

6.   She explained that the CIA was made of five intelligence products: geographical impact assessment, Recovery Progress Index (RPI), temperature check survey, community rapid needs assessments and place based ethnographic research. 

7.   She outlined that the Rapid Needs Assessmentswas a tool used by agencies in emergency situations to obtain a snapshot as to where resources were most requiredgeographically as well as tomarginalised and vulnerable communities. Ten groups were chosen for the RNA based on the risk of mortality such as those with chronic conditions, those in residential care and individuals from a Black, Asian and Minority Ethnic (BAME) group. Those groups had an eight, four or two-fold higher risk of mortality respectively than average. The vulnerability to socioeconomic impacts was the other criterion for selecting groups and cross-cutting themes emerged across other groups.

8.   The Advanced Public Health Information Analystsummarised that a mixed method analysis was used for the CIA including stakeholder interviews, prevalence mapping, quantitative and qualitative analysis. Criteria for interview participants were that key informants must be working closely with vulnerable residents and those residents in Surrey must have been able to provide consent.

9.   The initial findings were that:

·      BAME - the Advanced Public Health Information Analystexplained that data blind spots were encountered for the group as ethnicity was not recorded on death certificates and there was no updated information since the 2011 census. The group reported confusion around the messages as they were often not translated into different languages and there was more chance of household transmission due to the higher prevalence of inter-generational households.

·      Residential care - Personal Protective Equipment (PPE) and testing were thestrongest infection control strategies and PPE added large costs to care homes that had not been accounted for and the elderly found digital forms of communication challenging. 

·      Domestic abuse - the Consultant - Intelligence and Insights reported that lockdown had exacerbated pre-existing abuse with the closure of schools further exposing children, and the financial control of victims was exacerbated. Remote training of support staff was important to handle situations sensitively and there were opportunities to develop silent and digital forms of reporting.

·      Mental health - key issues were social isolation and the loss of coping mechanisms which were particularly problematic for those with dementia, access to services and care for patients, carers and front line staff and the long-term impact of job losses.

·      Crosscutting themes - communication, exclusion, isolation, stigma and rigidity of regulations.

·      Unexpected findings - positive findings included a wider uptake through use of online outreach tools, improved collaboration and greater attention to health inequalities. Negative findings included the prevalence of outdated views such as the stigma of mental health and chronic conditions and the stereotyping of how vulnerable people should behave as well as the complexity of overlapping vulnerabilities combining homelessness or domestic abuse with substance misuse and mental health.

10.  The Consultant - Intelligence and Insights noted that theCIA products were on track for publication on 23 October on Surrey-I, there was a communications engagement strategy in place with easy read versions; and the interim findings would be communicated to stakeholders and the CIA would inform decisions on future service delivery and resource allocation.

11.  A Board member highlighted that students was another group for consideration, there were two large university campuses in Surrey and residents were worried with the large influx during the pandemic. In response, the Consultant - Intelligence and Insights noted that oversight of that group was included in daily surveillance and communication. The Director of Public Health added thatthe team was working hard over the summer with universities on the matter who had put precautionary measures in place and with Guildford Borough Council on the night-time economy. Daily data was cut down by age groups and although nationally there was a rise in cases in young people, it was too early to know the impacts from term starting.

12.  A Board member noted the extra refuge and queried if there was any analysis on how many women’s refuges were needed. In response, the Consultant - Intelligence and Insights reassured members that initially during lockdown it had not been appropriate to engage with survivors, however the lead author was working on the next phase to talk to victims of domestic abuse.In addition, the Director – Commissioning responded that the new refuge had the capacity to take additional families. Refuge providers, local commissioners and colleagues from community domestic violence services met through the executive group and operational groups to discuss domestic abuse - the Board to be kept updated.

13.  A Board member queried whether rough sleepers were going back to the streets despite hotels and shelters providing accommodation.In response the Consultant - Intelligence and Insights noted that homelessness was being reviewed daily by Health Protection and would be followed up through the RNA findings. Another Board memberresponded that as a result of the Government’s ‘everyone in’ directive over 90% of rough sleepers had moved into settled accommodation or had shelter. She noted that since lockdown was lifted there were some rough sleepers in Guildford and Surrey Heath, but they were not the same cohort that were being supported pre-Covid.

14.  A Board member commented that compliance with the lockdown restrictions was generally good in the Gypsy, Roma and Traveller (GRT) community but that did not apply to unauthorised encampments. In response, the Consultant - Intelligence and Insights noted that a communities strategy group had been established to build on the work of the RNA. The Director of Public Health added that the team was working closely with the GRT community to ensure messages were culturally competent.

15.  A Board member queried whether armed forces serving personnel, veterans and their families had been engaged with. The Consultant - Intelligence and Insights responded that colleagues and partners were engaging with a wide range of communities including the armed forces - particularly concerning mental health, and insights continued to be amassed with crosscutting themes emerging.

16.  A Board member queried that aside from informing strategies in the long-term, whether there were immediate actions resulting from or was a timeframe for follow-up with the ten groups included in the RNA. She queried if the lead authors could choose a couple of actions that would make a big difference in the short- term and how the Board would keep track of progress and actions as they got dispersed into strategies. The Consultant - Intelligence and Insights responded that in conjunction with the Head of Analytics and Insight, she had been liaising with the lead authors on the actions arising and next steps.

17.  Regarding the RPI, a Board member suggested that citizen voice was needed and perhaps relating to the society aspect of the index. The temperature check was useful, but she queried whether something could be done on a rolling basis to ensure there was citizen reported feedback in the RPI. She also suggested that it might be beneficial to include screening into the RPI to see how people were re-engaging with health services. In response, the Head of Analytics and Insight commented that there would be an update on the RPI later in item 8 and would look at bringing different indicators into it, thanking the Board member for her suggestions.

18.  In response to a Board member’s query on the level of involvement with children and young people in the mental health piece of work, the Consultant - Intelligence and Insights commented that there were tactical insights and actions had gone to the relevant forums with the lead author linking in there.

RESOLVED:

The Health and Wellbeing Board:

1.    Acknowledged the issues highlighted in the Community Impact Assessment (CIA) and asks lead officers to incorporate them into the Health and Wellbeing Strategy.

2. Supported the use of the CIA findings to refine the target populations in the Health and Wellbeing Strategy and instigate actions within the delivery plans to tackle the impact of COVID-19 on at risk and vulnerable communities.
3. Provided individual and collective leadership to ensure CIA findings are incorporated into organisational strategies and inform decisions around future service delivery and resource allocation.
4. Supported the proposal for the CIA steering group to become the Joint Strategic Needs Assessment steering group when the CIA is complete.

Actions/further information to be provided:

1. Concerning domestic abuse, the Board will be kept updated on refuge provision.
2. Officers will liaise with the report authors in order to keep the Board informed of the immediate actions and their dispersal into various strategies concerning the ten groups included in the RNA.
3. Officers to consider the inclusion of citizen voice on a rolling basis and how people re-engaged with the health services possibly through screening.