Corporate report

UKHSA Advisory Board: Equalities, Ethics and Communities Minutes

Updated 16 September 2024

Date: 17 September 2024

Sponsor: Graham Hart

1. Recommendation

The Advisory Board is asked to note the minutes of 30 April 2024 meeting of the Equalities, Ethics and Communities Committee. The minutes were agreed on 16 July 2024.

2. Minutes (confirmed), UKHSA Equalities, Ethics and Communities Committee, 30 April 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
• Scott McPherson – Director General, Strategy, Policy and Programmes
• one member had their name and title redacted

In attendance were:

• 12 attendees had their names and titles redacted

Apologies:

• Hannah Taylor – Director, Policy

3. Welcome, apologies and declarations of interest

24/025 The Chair welcomed participants to the meeting, noted apologies, and confirmed that there were no declarations of interest.

24/026 Dame Jennifer Dixon’s role as a member of the Advisory Board and Equalities, Ethics and Communities (EEC) Committee had ended in April 2024. She was thanked for her valuable contributions to the EEC Committee alongside Oliver Munn whose fixed term position at UKHSA concluded in March 2024.

4. Minutes of the previous meeting and actions

24/027 The Equalities, Ethics and Communities Committee agreed the minutes of the 24 January 2023 meeting (enclosure EEC/24/006) and noted the action log (enclosure EEC/24/007).

5. Delivering Health Equity for Health Security Strategy

24/028 The Director, Health Equity and Clinical Governance introduced the update on progress of the Health Equity for Health Security Strategy (enclosure EEC/24/008). Year 1 had provided important baseline data for the organisation with the aim to improve any gaps in data availability. The team noted the ability to deliver system partnership work was impacted by changes in the health sector (that is Office for Health Improvement and Disparities and NHS at national and local level).

24/029 Upcoming milestones included finalising the Year 2 action plan and publishing the strategy externally. The Year 2 action plan would include more focused outcome metrics to build on accountability and delivery aspects.

24/030 The EEC Committee noted the progress in delivering the Year 1 strategic action plan of the Health Equity for Health Security Strategy and welcomed the real-time learning from action plan.

24/031 Discussion followed with recommendations as below:

• the action plan was welcomed although some areas focused too heavily on outputs rather than outcomes – although challenging to define, it was suggested to add more descriptive population level metrics
• the ambition of Year 1 action was admired; it was recommended to set clear deliverables associated with outcomes to set a realistic year 2 plan
• there was potential for greater engagement with local government, especially with new structures and elected representatives, such as regional mayors who would have a health equity focus – Advisory Board members were open to facilitating local engagement as appropriate
• it was advised that the update to the July Advisory Board should include a reminder of the CORE20PLUS approach
• it was suggested that Health Protection Research Units from UKHSA and the National Institute for Health Research could support the evidence base for UKHSA’s health equity work enabling delivery on the action plan
• the narrative for critical importance of health equity and health economics assessment would be important in a political context – UKHSA were exploring a collaboration with the University of York on health economics work targeting predominantly inclusion health; additionally, multi-pathogen screening in prison and asylum settings provided useful data to support health economics’ and cost effectiveness analysis of interventions

24/032 It was agreed to develop an exceptions report from the Health Equity Board that would be shared with the EEC Committee for information on key developments. (Action: Shona Arora / Name redacted)

6. Update on Heath Security Threat Assessment (HSTA) Tool and Future Scenarios Project

24/033 The All Hazards Directorate presented an update on the HSTA and Future Scenarios Project (enclosure EEC/24/009). The HSTA with Inequalities Impact Assessment (IIA) outlined the key findings from assessment of health threats over a 5-year timeframe. This is being used to support the Preparedness Cycle and exercises. The Future Scenarios project described the 4 scenarios that portray a divergent future for the UK and the health environment over a 15-20 year timeframe. The output of this work would be used as a tool to support strategic future planning, and to test potential new policies or initiatives in conjunction with foresight techniques.

24/034 The EEC Committee noted the status of the HSTA including the IIA and Future Scenarios Project. The team drew on published and unpublished literature to consider how health threats and the choice of mitigation could disproportionately affect certain groups.

24/035 Discussion suggested that UKHSA should consider:

• moving beyond the framework for assessment and utilising the insights to change the approach to addressing health equity impacts
• how UKSHA works with communities to ensure mitigations are appropriate and community driven
• sharing the work more widely in the agency to keep health equity embedded in all areas of UKHSA activity
• socialising with a wider group to strengthen assumptions in the IIA

24/036 It was agreed to share a copy of the final IIA report with the EEC Committee. (Action: Name redacted)

7. Increasing use of artificial intelligence (AI) from equity, ethics and community dimensions

24/037 [Title redacted] presented the paper on ethical and equality aspects of UKHSA’s approach to adoption of AI (enclosure EEC/24/010). There was significant interest within government on the use of AI and large language models.

24/038 The EEC Committee noted the developments in UKHSA’s use of AI and approach to organisational readiness for adoption and utilisation of AI. UKHSA’s strategic approach ensured consistency across the agency and included:

• mapping adoption across UKHSA
• establishing a governance framework with oversight from the AI Steering Committee
• utilising existing processes (for example Caldicott guardians, data impact assessment and expert knowledge judging appropriate use of AI) while regulatory frameworks were developed across government

24/039 The EEC Committee noted the findings of the Artificial Intelligence Security Threat Assessment. Key risks areas included:

• the impact of bias in AI models exacerbating existing health inequalities
• unequal access to AI (for example literacy, geographical location)
• erosion of trust in government and health bodies impacting the willingness of communities to share data, engagement with upskilling and representation of all groups in data

24/040 Discussion followed noting important equalities, ethics and communities aspects as below:

• validated data should be used to support adverse events projects (for example MHRA safety base) alongside use of internal data (for example HPZone)
• UKHSA should consider issues of equality in a connected way across government to avoid ill-considered adoption in the interest of keeping pace with AI development – it was noted that human involvement was an important factor in assessing current use cases
• it was important to take a multidisciplinary approach learning from behavioural science, policy, education
• ethical principles should be built into any framework developed internally and the collaborative frameworks developed across government
• beware of publication bias in the data used for AI models which may for example suggest the uptake of interventions with limited efficacy for target populations because reports on failed interventions have not been published (for example for specific inclusion groups such as the homeless)
• learn from other organisations’ use of AI
• expert knowledge of AI teams must be translated to address any gaps in other staff knowledge to achieve effective adoption
• it was important to consider potential opportunities from AI that could address existing health inequalities (for example modelling vaccine uptake, transmission routes for infectious disease in place-based settings such as prisons)

24/041 The EEC Committee endorsed the use of an AI Steering Committee to consider use across the agency. It was recommended to include an ethics presence on this committee and to consult the Science and Research Ethics Committee when considering AI use cases. (Action: Name redacted)

24/042 The team were thanked for their presentation and welcomed to return to the Committee on progress when developed further (minimum 6 months).

8. Forward look and topics for future meetings

24/043 The Equalities, Ethics and Communities Committee noted the Forward Look (Enclosure EEC/24/011).

24/044 Teams were thanked for their comprehensive papers. Reflections from members suggested:

• papers should be clear on covering all aspects of the committee’s remit
• presentations could be shorter with less detail on slides to allow more time for discussion, given that the Committee will have read the papers ahead of the meeting

9. Any other business and close

24/045 [Title redacted] provided an update on Adult Social Care since the January discussion. Teams had taken on feedback to be proportionate in what was achievable

24/046 Progress included:

• principles to support safe planning and visiting adult social care during an outbreak were available on gov.uk
• teams were looking at vaccine gaps in measles, mumps and rubella for young adults with learning disabilities and pneumococcal in adult social care
• the data oversight group would meet in June to understand gaps in current study data (for example Vivaldi COVID-19 study)

24/047 The meeting closed at 15:51.