Corporate report

UKHSA Advisory Board: Equalities, Ethics and Communities Committee minutes

Updated 29 January 2024

Date: 31 January 2024

Sponsor: Graham Hart

Recommendation

The Advisory Board is asked to note the minutes of 10 October 2023 meeting of the Equality, Ethics and Communities Committee. The minutes were agreed on 23 January 2024.

Minutes (confirmed), Equalities, Ethics and Communities Committee, 10 October 2023

Present at the meeting were:

• Graham Hart – Non-executive Chair

• Susan Hopkins – Chief Medical Advisor and Executive Lead

• Shona Arora – Director, Health Equity and Clinical Governance

• Jennifer Dixon – Non-executive member

• Marie Gabriel – Associate non-executive member

• Mark Lloyd – Non-executive member

• Oliver Munn – Director General, Health Protection Operations

• Hannah Taylor – Director, Policy

• one attendee had their name and title redacted

In attendance were:

• Michelle Kane – Director, NHS England

• Mary Ramsay – Director, Public Health Programmes

• Paul Sutton – Director, Emergency Preparedness, Resilience and Response

• Will Welfare – Director, Regions - Health Protection Operations

• 13 attendees had their names and titles redacted

Apologies were received from:

• Raj Long Associate – Non-executive member

• Scott McPherson – Director General, Strategy, Policy, and Programmes

Welcome, apologies and declarations of interest

23/072 The chair welcomed participants to the meeting, noted apologies, and confirmed that there were no declarations of interest.

Minutes of the previous meeting and actions

23/073 The Equalities, Ethics and Communities (EEC) Committee agreed the minutes of the 14 July 2023 meeting (enclosure EEC-23-017).

23/074 The EEC Committee noted that 3 of the actions had been completed and one was in progress (enclosure EEC-23-018). Full explanations were provided.

23/075 On action 23/066, it was noted that the Health Equity Team’s presentation on health and justice at the HM Prison and Probation Service’s (HMPPS) Audit and Risk Committee was well received; and that the chair had thanked the EEC Committee for alerting them to UKHSA’s critical work and confirmed that the issues raised would remain a focus for their HMPPS Executive.

EEC Committee effectiveness review

23/076 The EEC Committee noted the Chair’s Annual Report 2022 to 2023 and the findings of the 2022 to 2023 Effectiveness Review (enclosure EEC-23-019).

23/077 The EEC Committee endorsed all the recommendations for implementation in the 2023 to 2024 reporting year.

23/078 On section 4.3 (b), it was noted that the report covered the first 2 meetings from foundation and that since then, as the EEC Committee matured, constructive challenge from the non-executive members had strengthened.

23/079 On section 4.3 (c), the non-executive members confirmed that they were content to provide advice, support and constructive challenge on pieces of work outside of committee meetings.

Winter planning, health inequalities, and community approaches

23/080 The Director General, Health Protection Operations and the Director of Regions gave an update on planning and preparedness for winter 2023 to 2024 (enclosure EEC-23-020).

23/081 The EEC committee noted the new activity planned for 2023 to 2024, which included:

• the transition from bespoke winter incident response arrangements to business-as-usual arrangements
• focus on separate and concurrent winter threats through joint planning, preparedness, early identification and assessment
• analysis in more granular detail across different population groups
• combining flu and COVID-19 as a winter package in external communications
• working with local partners to strengthen multiagency structures for winter response

23/082 The EEC Committee noted that consideration of multiple systems pressures was being built into UKHSA’s winter planning and the intelligence shared at local and regional levels. This included the impact on service delivery from industrial action by junior doctors and consultants.

23/083 Discussion took place on potential non-pharmaceutical measures that could be leveraged if the health system became strained over and above normal seasonal pressure. The EEC Committee noted that there was much that could be done on strengthening communications on existing guidance around voluntary measures. School and care home closures would continue to be a localised decision and these were last-resort measures as multiple risks would need to be balanced to avoid knock-on effects across the health system.

23/084 The EEC Committee noted that UKHSA was building a new data and analytics dashboard, had recently completed a review of its surveillance systems, and was making progress on improving data access and quality, including the acquisition of real time data for strengthened forecasting.

Building confidence and addressing inequalities in the national immunisation programmes: a round table discussion

23/085 The Director of Public Health Programmes gave an update on UKHSA’s work to improve uptake and equitable access of routine immunisation programmes (enclosure EEC-23-021).

23/086 The EEC Committee discussed research that showed a consistent underreporting of vaccinated people due to challenges with GP record keeping and transfer of records when people move location, which made it difficult to identify, and, therefore, target, genuinely unvaccinated people. The EEC Committee commented on the need for a single shared record of immunisation as with COVID-19, for example in the form of a national vaccine register, alongside mechanisms and resources to chase and update records as part of routine immunisation services.

23/087 There was discussion on research that showed an association between supply side structural weaknesses and the declining immunisation uptake in recent years, as opposed to demand-side vaccine confidence. In addition, single GP practices, more dominant in deprived areas, were found to be particularly struggling with demand. It was suggested that a mixed service delivery approach was needed to improve capacity and accessibility through leveraging different providers, such as pharmacies, to provide supplementary services. With research having shown that the NHS remained the most trusted source of information on immunisation, the GP service delivery model should remain at the core of any mixed model of immunisation delivery.

23/088 The EEC Committee further commented that any mixed service delivery model should be place-based to consider the myriad of practical challenges people face within communities and localities in accessing immunisation services. Examples were discussed from UKHSA’s pilot projects in London and the South West. With the closing down of community infrastructure in recent years (for example, libraries, public spaces), the EEC Committee recommended building a wider coalition of community partners to help drive vaccine uptake.

23/089 Discussion noted the loss of digital ecology on vaccines and immunisation programmes and the potential for a dedicated UKHSA with NHS endorsement website on vaccines and immunisation to provide relevant information to the public. The EEC Committee recommended non-digital communications also be developed, such as post cards and videos for community spaces, to reach the digitally disenfranchised. The EEC Committee noted UKHSA’s strategy of issuing communications in multiple languages and other formats including Easy Read, Braille and British Sign Language but recommended that purely non-verbal pictorial communications be developed in addition for those who use spoken languages or have limited written literacy. Local contexts could be considered through a place-based approach to service delivery.

23/090 There was discussion on the impact of NHS restructuring on immunisation services and the potential risks of current NHS organisational changes including loss of capability, funding, and corporate memory. Restructuring had created challenges to providing sustained core and supplemental immunisation services. The EEC Committee noted the need for the recognition of immunisation as a clinical specialty to provide system leadership, and for a structure and capability to provide oversight and assurance to a mixed place-based service delivery model.

23/091 The Public Health Programmes Directorate to return to the EEC Committee with an update in one year’s time.

(Action: [Name redacted] / Mary Ramsay)

23/092 The Public Health Programmes Directorate to discuss potential research collaborations with non-executive member Jenifer Dixon.

(Action: Mary Ramsay)

23/093 Non-executive members to raise issues around improving uptake and equitable access of routine immunisation with their respective organisations (Health Foundation, ICS network) and consider how they can support this initiative. The Public Health Programme Directorate to provide key points to share and potential asks.

(Action: Mary Ramsay/ Jennifer Dixon / Marie Gabriel / Graham Hart)

Forward look and topics for future meetings

23/094 The Equalities, Ethics and Communities noted the Forward Look (enclosure EEC-23-022).

23/095 The Chief Medical Adviser to discuss with the Director General, Strategy, Policy and Programmes on taking a paper on system level risks in health service delivery to a closed session of the Advisory Board.

(Action: Susan Hopkins)

Any other business and close

23/096 Thanks were noted to all participants for their papers and contributions. The meeting closed at 12:10pm.

October 2023