Report attached.

The Long Covid clinic at BHRUT had received coverage in the national and international news. Access to the Long Covid service was best in Havering although there were lower levels of referrals to therapeutics. A team and learning approach was adopted in the Trust’s approach to treating Long Covid.

On the issue of enhanced access to primary care, an increase would be implemented from October 2022 to 60 minutes worth of appointments being available per 1,000 patients. One GP surgery in each primary care network would be required to offer appointments 6.30 – 8.30 pm on weekday evenings as well as 9 am – 5pm on Saturdays. This would be in addition to the existing GP hubs.

The new service was based on 28,000 patients responding to a survey. On line booking of GP appointments was not available yet – this was a national issue. It was noted that enhanced access in the Crest Primary Care Network would commence at the Rush Green Medical Centre but that this may move to Raphael House. Bookings would be able to be made either on the day or up to two weeks in advance. Patients would be seen by a multi-disciplinary team.

The existing GP access hubs would continue until March 2023 at which point the service would be reviewed. A Member raised the older demographic of residents in the east of Havering but officers explained that a hub had been established in the south of the borough to be a facility for the under-served areas in South Hornchurch and Rainham. It was necessary to take a realistic view with such facilities and this could be addressed over time.

It was accepted that there was understaffing in Havering for GPs, GP nurses and Health Care Assistants. A scheme to attract GPs who wished to further their areas of interest had proved successful and it was aimed to increase the number of GPs and GP nurses in Havering by 2025. Better staff training and development was also being introduced to improve retention of staff.

Local work was looking at upskilling existing staff to e.g. assist with the vaccination programme and offer more opportunities for work experience across the borough. The enhanced access to primary care model could be assisted by bank doctors if there were staffing issues. Bank nursing could also be used to provide out of hours primary care cover.

The Council’s Director of Public Health advised that health inequalities referred to unfair, avoidable or systematic differences in health outcomes. This was also impacted by wider determinants of health such as smoking rates, income levels, housing and access to and the quality of health & care services. Other factors included ethnicity, gender and the location in which people lived.

Inequalities assessments were carried out but it was felt that Members could scrutinise this area as they had a collective responsibility to ensure decisions were robust. The inclusion of health & sustainability comments in reports of Council Executive Decisions was currently being considered.

Life expectancy in Havering was very similar to the national average. There was however a seven year difference in life expectancies in Havering, depending on deprivation levels. It was difficult to quantify life expectancy by ethnicity as ethnicity had only recently begun to be recorded on death certificates. A national analysis of life expectancy by ethnicity could be shared. Members felt this was increasingly important given the borough’s changing demographics. Perhaps health messages could be given directly to faith groups.

The Director of Public Health felt that community engagement had improved during the pandemic. Members agreed but felt that data could be used to target interventions. For example the poor life expectancy in Harold Hill could be investigated.

Other inequalities issues included still births, a low birth rate and levels of childhood obesity. There were also inequalities in health care with for example lower participation in cancer screening in some communities. Uptake of immunisations such as the Covid-19 vaccine also varied across communities. Mortality rates during the pandemic had varied across Groups.

The Marmot review had been undertaken on health inequalities but this had focussed on poverty issues rather than healthcare. The NHS had plans to tackle health inequalities and it was emphasised that some Havering communities were in the 20% most deprived in the UK.

A Member felt that the Council should have a consistent assessment mechanism for health inequalities. Data from the 2021 census was awaited and this was likely to have an impact on the Equalities Impact Assessment used at the Council. This would lead to policies that, whilst improving health for everyone, would bring the most improvement for the most deprived.

Members felt that health equalities issues to be considered included future policies to enhance health in the Romford and Harold Hill areas. Granular local data on health inequalities could be brought to a future meeting of the Sub-Committee. An update on the health inequalities position in the Romford area could also be given.