Agenda item

The report provides an update on the Covid-19 Community Impact Assessment (CIA) which explores how communities across Surrey have been affected by Covid-19. The report also provides an update on the Local Recovery Index (LRI, formerly known as the Recovery Progress Index) which is a surveillance tool for monitoring the impact of, and how well Surrey is recovering from, the effects of the Covid-19 pandemic and subsequent lockdown. It is a specific product of the CIA and looks at a range of indicators across four themes: Economy, Health, Society, and Transport and Travel, and forms a subset of the Social Progress Index (SPI). The SPI directly measures societal progress in the areas of Basic Human Needs, Foundations of Wellbeing, and Opportunity at county, borough and district, and ward levels.

 

 

 

 

Witnesses:

Rob Moran - Chief Executive, Elmbridge Borough Council (Priority Three Sponsor)

Dr Naheed Rana - Health Consultant - Intelligence and Insight (SCC)

Rich Carpenter - Data Scientist - Insights, Analytics and Intelligence (SCC)

Satyam Bhagwanani - Head of Analytics and Insight (SCC)

Hayley Connor - Director – Commissioning (SCC)

 

Key points raised in the discussion:

 

1.      The Chairman explained that the Community Impact Assessment (CIA) was an excellent piece of work that measured and highlighted the disproportionate impact that Covid-19 has had on Surrey’s communities.

2.      The Chairman explained that over the coming year, four workstreams would be combined to provide a more comprehensive picture of what was happening across Surrey: the CIA which was currently broken down to borough and district level, the Social Progress Index which included national benchmarks, the Local Recovery Index which was Surrey’s version of SPI and the Health and Wellbeing Strategy metrics which measured key outcomes.

3.      The Chairman highlighted that partnership work was key to ensure attainment of the Council’s overarching priority that ‘no one is left behind’ as noted in the Community Vision for Surrey in 2030. He outlined the Council’s four strategic priorities of focus for the next five years: ‘tackling health inequality’ - through the four workstreams listed above, ‘growing a sustainable economy so everyone can benefit’ - by supporting local high streets and upskilling residents, ‘enabling a greener future’ - through the Surrey Greener Future Strategy to achieve a carbon neutral future by 2050, and ‘empowering communities’ - by working with partner organisations to increase engagement with residents.

4.      The Priority Three Sponsor noted that through the recommendations the Board would ensure it would address the findings from the CIA and the Local Recovery Index (LRI) as it was crucial that the priorities aligned with current Covid-19 recovery and future service planning. He praised officers’ work on the intelligence products within the CIA and particularly the Rapid Needs Assessments (RNA) which provided ten in-depth assessments of vulnerable communities; an easy read version was also available on Surrey-I.

5.      The Health Consultant - Intelligence and Insight (SCC) explained that the aims of the CIA were to explore the impact that Covid-19 has had on health, social and economic elements of Surrey’s communities and to understand the needs and priorities of communities for recovery.

6.      The Health Consultant - Intelligence and Insight (SCC) noted that the CIA was composed of five discreet intelligence products using a mixed method approach combining qualitative and quantitative data which interlinked forming a high-level analysis of Surrey’s diverse communities:

·         Geographical Impact Assessment (GIA) 

·         Temperature Check Survey

·         Rapid Needs Assessments (RNA)

·         Place Based Ethnography

·         Local Recovery Index (LRI)

7.      The Health Consultant - Intelligence and Insight (SCC) provided an overview of the first national lockdown which began on 23 March 2020 noting that:

·         the furlough scheme began on 19 March.

·         cases peaked in Surrey between April and May and started to fall towards the end of May.

·         there was a greater need for support with 40,000 vulnerable and shielded residents in Surrey contacted and the Surrey Community Helpline was stood up with high demand in March and April.

·         at the same time there was a decrease in demand for some services such as C-SPA (Children’s Single Point of Access).

·         national and local evidence highlighted that certain groups were impacted disproportionately from Covid-19 and so ten RNAs were undertaken across vulnerable groups with pre-existing vulnerabilities or a greater risk of mortality from Covid-19.

·         lockdown led to a decrease in mobility and economic activity such as the reduction of traffic flow and passenger bus journeys in the county.

8.      The Health Consultant - Intelligence and Insight (SCC) summarised the impacts of Covid-19 as highlighted through the CIA, noting that the:

·         health impacts had been felt the most in areas with higher numbers of over 80s and those in care homes and were mapped across the five most impacted areas in Surrey.

·         economic impacts had been felt the most in areas with a higher reliance on certain industries such as aviation and data was combined on estimated workers furloughed and increases in the claimant count, mapped across the five most impacted areas in Surrey.

·         residents who were not used to needing support struggled as evidenced from the Temperature Check Survey, the Place Based Ethnography and the RNAs with many seeking financial support such as Universal Credit and Jobseeker’s Allowance for the first time.

·         lockdown had impacted many people’s mental health, findings from the Temperature Check Survey and the Place Based Ethnography showed that 52% of those aged 16-25 said that they felt lonelier due to lockdown; across each of the RNAs mental health and wellbeing were significantly affected.

·         there were significant impacts on those already using mental health services, with key issues reported in interviews such as not knowing where to access services and support, the loss of coping mechanisms, the impact on staffing and on those with dementia, the fear of infection and social isolation.

·         lockdown exacerbated the impact on people experiencing domestic abuse, particularly pre-existing domestic abuse as for example the closure of schools further exposed children. It was vital to raise awareness as reporting became difficult due to remote working, the first RNA focussed on service providers and key informants and when possible, a further update would be published on Surrey-I once survivors could be contacted.

·         more people participated in unhealthy behaviours since the start of lockdown such as smoking tobacco and drinking alcohol, as shown by the Temperature Check Survey.

·         people from Black, Asian and Minority Ethnic (BAME) communities struggled to access support such as food or financial help. Key findings included an increased experience of racism and racial discrimination, the lack of clear communication of guidelines which were also culturally sensitive, and that social distancing was a challenge for families living in multi-generational households.

·         residents living in residential care homes had felt more isolated particularly due to the loss of mobility, digital forms of communication were challenging, adequate Personal Protective Equipment (PPE) was an issue as well as access to testing and limited visitors.

·         positive impacts from the pandemic included strengthened partnership working between service providers and the Voluntary, Community and Faith Sector (VCFS), a reduction in travel and air pollution and behavioural changes such as increase in time spent outdoors.

9.    The Health Consultant - Intelligence and Insight (SCC) detailed the strengthened partnership response across Surrey, highlighting that:

·         the Surrey Community Helpline had handled over 10,000 calls, 40,000 vulnerable and shielded residents in Surrey were contacted, a new community hospital had opened in just over a month, over 10,000 registered volunteers supporting the community delivering food boxes and over 7 million items of PPE were delivered to the front line.

·         regarding the Temperature Check Survey findings, the Health Consultant - Intelligence and Insight (SCC) noted that although the majority of vulnerable people had received the support they needed, there were a few areas of concern such as childcare - outreach needed to be increased.

·         there was a greater sense of community and neighbourliness, with over half reporting a positive impact on their connection to the local community.

·         some groups had felt excluded or stigmatised, several themes were identified through the ten RNAs: information, exclusion, isolation, stigma and rigidity of regulations.

·         there were gaps in service provision for some types of need, as crucially services with a lower demand had been harder to access. Shielded individuals and their carers felt there was a lack of contact from Adult Social Care and other support services. 

·         residents had found information around guidelines and rules confusing and there was a lack of culturally sensitive information.

10.   The Health Consultant - Intelligence and Insight (SCC) outlined the current second wave, noting that cases in Surrey had started to rise again in September taking Surrey’s total of cases to over 10,000 since the start of the pandemic; and that many residents had concerns regarding their long term physical and mental wellbeing and that of their family and friends. 

11.   Looking to the future, the Health Consultant - Intelligence and Insight (SCC) noted that:

·         local recovery efforts had started to show results since the easing of lockdown, with mobility trends around retail and recreation activities reverting to pre-pandemic levels. Although recovery and particularly the economic impact was uneven across the county.

·         residents indicated that the focus should be on supporting local businesses and vulnerable people in the county.

·         the CIA was published on Surrey-I and that the findings were being disseminated across key partners with strategic groups being established as well as alignment with phase 3 of the NHS’ response to Covid-19.

·         tackling misinformation and providing targeted communications was key, Covid-19 surveillance was carried out daily and mass vaccination was a key area of focus.

12.   The Data Scientist - Insights, Analytics and Intelligence (SCC) introduced the Local Recovery Index (LRI) which was a thematic subset of the Social Progress Index and measured Surrey’s recovery from the pandemic - return to pre-pandemic levels - and the impact that COVID-19 has had across three dimensions: economy, health and, society and infrastructure.

13.   The Data Scientist - Insights, Analytics and Intelligence (SCC) explained that the LRI produced a score and rank for each dimension and indicator to enable a comparison between areas. He provided a summary of the recently published quarter two scores and ranks, noting that there had been some movement between July-September 2020 since quarter one:

·         quarter two saw a reduction in infection rates and increased mobility, all three dimensions saw an increase in recovery, so the overall scores had improved for every borough and district.

·         the rankings of boroughs and districts changed slightly in that Tandridge ranked the highest for recovery whilst Spelthorne ranked the lowest. Woking which was ranked first in quarter one had dropped down the most.

·         a reduction in overall scores in quarter three was expected due to the second wave with increasing infection rates. Impacts on the economy continue to worsen with the increase in claimants for Universal Credit, although furlough had some beneficial impact.

14.   The Data Scientist - Insights, Analytics and Intelligence (SCC) provided an update on the Social Progress Index (SPI) which although paused in response to Covid-19, some work was undertaken in the background as 70% of the data for the indicators had been collected. Work on the LRI was useful as it acted as a test of the process of the SPI using the same methodology.

15.   The Data Scientist - Insights, Analytics and Intelligence (SCC) noted that there was a workshop early in the year on the SPI with partners to formulate key indicators which had since been shortlisted.

16.   The Data Scientist - Insights, Analytics and Intelligence (SCC) added that piloting indicators at borough data in Elmbridge had been resumed, with data collected down to ward level. A beta version of the Surrey SPI was planned to be produced by early next year and asked Board members to help with data collection and partners would be consulted on regarding the draft indicators within the four components under the three dimensions.

17.   The Head of Analytics and Insight (SCC) noted that the team was happy to receive any feedback on the intelligence products.

18.   A Board member praised the dedication of officers and was encouraged by the determination to get the data and information out to key partners that support hard to reach groups which was crucial particularly as there was often a deep sense of mistrust and a single source of truth in certain communities.

19.   A Board member highlighted that according to the evidence, Surrey’s communities should be given credit for their stoic acceptance of the severe restrictions; as from the policing side there was no widespread flouting of the restrictions. The data showed that social isolation was a damaging impact of the restrictions and must be addressed.

-       The Priority Three Sponsor noted that although there was initial pushback and queries from residents when Elmbridge was the first area in Surrey to be moved into Tier 2 in October, he positively noted the compliance of Surrey’s residents with the restrictions.

-       A Board member echoed the stoicism reported to Healthwatch Surrey and gratitude of the services people have had, she emphasised the importance of taking note of the feedback during the pandemic as people were reluctant to speak out.

20.   A Board member noted that it was encouraging that the majority of vulnerable people who needed help received the support they needed but highlighted that the single most negative perception of residents who needed help was in childcare as only 15% felt they received effective support and access to services. He hoped that the issue would be given greater priority by the Council as the Local Education Authority moving forward to develop a more coherent approach going forward in response to the haphazard closure and reopening of educational settings. However, he recognised the challenging circumstances of the ever-changing situation and the excellent provision stood up by educational settings.

-       In response the Director – Commissioning (SCC) noted that it was important to recognise that schools and early years settings did an incredible job during wave one when they had to close and subsequently when they had to reopen with social distancing measures and bubbles.

-       She recognised that it was difficult for parents working at home to juggle childcare and home learning; and that schools stayed open for the children of key workers and children with defined health, education, or social needs. Going forward it remained important to look at how the Surrey community and employers support members of staff with childcare whilst working at home.

21.   A Board member queried that given the wealth of information from the CIA and the intelligence products, what the role of the Board was in having oversight of how that work was progressed. She asked whether the Board would receive a concise set of prioritised recommendations so that the Board could hold itself publicly accountable on how the CIA and intelligence products have informed various workstreams and how would the Board map that in relation to the priority boards.

-       The Priority Three Sponsor responded that the work only had value if it has utility within organisations and the Board has oversight of how the work is permeated through their work.

-       A Board member highlighted the comments in the Microsoft Teams chat noting that the CIA and intelligence products were already permeated through ICPs, with an insight in recovery and restoration being presented in a later item from Surrey Heartlands CCG on the health inequalities work underway across the system. The tableau dashboard looked progress regarding the Health and Wellbeing Strategy, with more detailed annual review by the Board of the Strategy’s metrics at its next meeting.

-       The Health Consultant - Intelligence and Insight (SCC) noted that the team had offered some design workshops to different partners to look at integrating the findings and priorities along with the Strategy to ensure action.

22.      Regarding the LRI, a Board member noted that from public point of view there were many health dimensions not included in the LRI, which as referenced in the paper was due to data not being available at the borough and district level. As for example mental health, rates for screening and immunisations, and return to normal for elective and urgent care were concerns to residents, she asked whether there were any next steps to get that data.

 

Dr Andy Brooks left the meeting at 2.52 pm

-      In response, the Priority Three Sponsor noted that if such data was available that it should be captured so that the work followed an iterative and ongoing process adding to the richness of data.

-      Regarding data collection on the LRI, the Head of Analytics and Insight (SCC) added that his team took that action away from the last Board and was being followed up through discussions with colleagues from Surrey Heartlands CCG and acute trust colleagues. He added that geography posed a challenge as for example waiting times information was available at NHS Trust level in Surrey, so the team was looking at how that data could be made available at borough and district level.

-       The Health Consultant - Intelligence and Insight (SCC) noted that the CIA and RNA highlighted the health inequalities angle exacerbated by Covid-19. There were multiple workstreams and various indicators relating to health inequalities, so it was key to align those pieces of work whether through the LRI or through the comprehensive dashboard which was in development, to look at those health inequalities in consultation with healthcare partners.

23.      The Priority Three Sponsor thanked officers for their expertise and ongoing work and that it was up to Board members to ensure that the findings were integrated into their organisations. Partnership work was vital to ensure collective ownership and the findings showed the insidious impact of loneliness and isolation in communities and the exacerbation of domestic abuse which must be addressed.

24.      The Chairman thanked the Priority Three Sponsor for leading on the partnership work and emphasised that the CIA and intelligence products underpinned the Strategy’s priorities. He thanked all and noted that the Board will follow up on the item in the upcoming year to ensure that improved outcomes were being delivered particularly targeting those vulnerable groups and communities identified.

 

RESOLVED:

That the Health and Wellbeing Board:

1.      Considered how the findings from the Covid-19 Community Impact Assessment can best be incorporated into the council’s strategic, financial and service planning and delivery.

2.      Acknowledged the issues highlighted in the LRI and asked lead officers to incorporate them into the Health and Wellbeing Boards planning and response to Covid-19.

3.      Supported the use of the LRI findings to refine the target communities and themes 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.

4.      Provided individual and collective leadership to ensure LRI findings are incorporated into organisational strategies and inform decisions around future service delivery and resource allocation.

5.      Acknowledged the proposals for the SPI and provides individual and collective leadership to ensure the SPI benefits from board members unique oversight and expertise to help us tailor the SPI framework for Surrey.

6.      Highlighted areas or issues of interest and for future focus in terms of further research and analysis.

Actions/further information to be provided:

1.    The Board will receive a beta version of the Surrey SPI in due course, including the pilot in Elmbridge and Board members are to help with data collection and partners will be consulted on the draft indicators.

2.    The Board will continue to have oversight over the progression of the CIA and the intelligence products on how they will inform and permeate through workstreams across organisations concerning both current Covid-19 recovery and future service planning; and mapping that in relation to the priority boards. An update will be received by the Board in due course to ensure that improved outcomes were being delivered particularly targeting those vulnerable groups and communities identified.

3.    Officers will ensure that the many workstreams and various indicators relating to health inequalities are aligned whether through the LRI or the more comprehensive dashboard through partnership working to capture data at the borough and district level.