Date: 19 November 2024

Sponsor: Graham Hart

1. Recommendation

The Advisory Board is asked to note the minutes of 16 July 2024 meeting of the Equalities, Ethics and Communities Committee. The minutes were agreed on 8 October 2024.

2. Minutes (confirmed), UKHSA Equalities, Ethics and Communities Committee, 16 July 2024

Present at the meeting were:

• Graham Hart – Non-Executive Member of UKHSA Advisory Board (Chair)
• Shona Arora – Director, Health Equity and Clinical Governance
• Susan Hopkins – Chief Medical Advisor (Executive Lead)
• Marie Gabriel – Associate non-executive member
• Mark Lloyd – Non-Executive Member of UKHSA Advisory Board
• Raj Long – Associate Non-Executive Member of UKHSA Advisory Board
• Scott McPherson – Director General, Strategy, Policy and Programmes

In attendance were:

• Will Welfare – Director, Regions
• 16 attendees had their names and titles redacted

Apologies:

• Hannah Taylor – Director, Policy

3. Welcome, apologies and declarations of interest

24/048 The Chair welcomed participants to the meeting, noted apologies, and confirmed that there were no declarations of interest.

24/049 Participants were welcomed including the Clinical Fellow and Accelerate Programme member from the Chief Medical Advisor’s office.

4. Minutes of the previous meeting and actions

24/050 The Equalities, Ethics and Communities Committee agreed the minutes of the 24 April 2024 meeting (enclosure EEC/24/012) and noted the action log (enclosure EEC/24/013).

5. Effectiveness Survey

24/051 The Equalities, Ethics and Communities Committee noted the Annual report for 2023/24 and the results of the Effectiveness Review (enclosure EEC/24/014). The frank feedback from colleagues was appreciated.

24/052 The Equalities, Ethics and Communities Committee agreed the suggested recommendations.

24/053 Further reflections noted:

• it was positive to see the breadth of topics covered by the Committee;
• UKHSA staff valued the mix of support, challenge and strategic overview of elsewhere in the health system. In particular, practical support such as the letter written to HM Prison and Probation Service;
• presenting teams thanked the Governance team for updated commissioning material in July which included requirement for papers to cover all 3 aspects of the Committee’s remit;
• members were encouraged to provide feedback on the support they wanted from the Committee;
• there was opportunity under new government to build traction in some areas and highlight the importance of ethics and communities approaches.

6. Approaches to Community Engagement

24/054 The [Title redacted] presented the paper on building relationship and working with community to strengthen UKHSA’s strategic priority areas of work (enclosure EEC/24/015). A task and finish Group was established to identify how UKHSA can build its partnership with communities. Existing engagement with CORE20PLUS groups mapped onto new engagement model indicating opportunity to strengthen engagement beyond an ‘inform’ approach.

24/055 The Equalities, Ethics and Communities Committee noted the early progress made to strengthen approach to community engagement in UKHSA and its contribution to achieving more equitable outcomes.

24/056 Discussion raised the following points:

• live examples would encourage ‘buy in’ to implementing the conceptual framework and visibility of current engagement;
• the importance of national engagement for national products (e.g. flu campaigns) alongside local and regional community engagement. Building sharing of insights and coordination across UKHSA teams would provide opportunity to showcase national campaign capability to new ministers;
• providing a face behind UKHSA’s advice built trust with communities and clarity on source of information;
• an assurance group consisting of people across UKHSA supported accuracy of messaging delivered by others;
• utilising existing information would reduce duplication and support capacity to achieve quality engagement;
• building awareness of community engagement within UKHSA would leverage our people as our greatest advocates and ambassadors;
• engagement should be as close to the community as possible and take account of non-geographical communities; it was vital to unpack the concept of community allowing stratification of work;
• multiple inputs in multiple places would ensure long term impact;
• engagement with and through elected mayors strengthen the value of localised messaging.

7. System-wide engagement with Integrated Care Systems (ICSs)

24/057 The Director, Regions - Health Protection Operations and [Title redacted] introduced the update on current approaches to system-wide engagement on health protection, including with ICSs (enclosure EEC/24/016).

24/058 Effective engagement with partners across the complex health protection system was vital to improve health outcomes. The ICS brought together NHS organisations, local authorities and other stakeholders to take collective responsibility for planning services. ICS provided a series of formal ways to engage but was not always easy to understand with varied knowledge of UKHSA’s work across the ICS. UKHSA was focused on utilising relationships by ensuring commonality in engagement with Integrated Care Boards (ICBs) and aligning UKHSA’s priorities with those of ICBs.

24/059 In addition to ICB engagement, UKHSA worked with system-wide partners in England via the Future of the Health Protection System (FHPS) to enhance the resilience, effectiveness and scalability of national and local health protection. Priorities of the FHPS were defined by membership with all supporting ambitious but realistic changes in the health protection system. Utilising UKHSA’s convening power within the group was seen as an effective way to drive engagement.

24/060 The Equalities, Ethics and Communities Committee noted the update which clarified UKHSA’s approach.

24/061 It was suggested that:

• understanding duties from the ICB perspective was a useful engagement point;
• the variety of relationships within some regions was key to understanding specific regional challenges;
• UKHSA needed to clarify why it wanted to engage with and be clear on what was expected of ICBs;
• a set of key messages from UKHSA that could be applied consistently across the system would be valuable;
• it may be beneficial to invite a Place Director to a future Committee meeting;
• learnings from engagement with ICBs should be shared with the devolved administrations to understand how they address similar issues.

8. Public health ethics in practice

24/062 The Clinical Fellow presented the paper (enclosure EEC/24/017) on transferable learning from an extensively drug-resistant tuberculosis (XDTRB) expert multidisciplinary panel in an individual case of XDTRB. It included an exemplar ethical framework initiative which incorporated a novel risk-based methodology and input from a public consultations group.

24/063 [Information redacted in accordance with the Freedom of Information Act 2000.]

24/064 An advisory panel was established reporting to the Incident Management Team and included a lay member with experience of tuberculosis. A novel risk assessment matrix was developed for the panel to consider risk to the individual and risk to the public. The novel risk-based methodology could support good quality ethical decision making in future health protection scenarios.

24/065 The Committee thanked the [Title redacted] for presenting the complex situation well. It supported conversations on ethics in complex public health decision making which required different perspectives from ethics in research or medical settings.

24/066 Discussion raised the following points:

• the intervention had changed the quality of partnership conversations and would impact ongoing quality of interventions. It strengthened final decision making of the Incident Management Team and established UKHSA as a respected source of advice for the local authority and hospital;
• the individual case underpinned the need for facilities or changes in legislation. It was noted that legal frameworks in clinical ethics were much stronger than in public health. UKHSA policy teams could support and advocate improvement in policy approaches or legal frameworks;
• UKHSA should utilise the learnings from case and principles used in other highly infectious scenarios as there may be other interventions /approaches that could be used depending on the complexity of the case;
• whilst the panel approach had consumed considerable time and resource, for the reasons outlined above it was felt that in this instance it is likely that the time spent for this novel methodology approach would provide direct public health benefit and could save many future hours for clinicians and the many others involved in managing this complex case.

9. Forward look and topics for future meetings

24/067 The Equalities, Ethics and Communities Committee noted the Forward Look (enclosure EEC/24/018).

24/068 It was noted that:

• discussion on sector wider engagement and the Integrated Care Systems may be a suitable topic for the Advisory Board;
• the next meetings should open with reflections on the priorities of the new government.

10. Any other business and close

24/069 Thanks were noted to [Name redacted] for all her support to the Equalities, Ethics and Communities Committee.

24/070 The Committee noted the exceptions report from the Health Equity Board which ensured oversight of equity work across the organisation.

24/071 The meeting closed at 3:44pm.