Corporate report

UKHSA Advisory Board: UKHSA’s approach to delivering health equity for health security

Updated 22 May 2023

Date: 24 May 2023

Sponsor: Susan Hopkins and Scott McPherson

Presenter: Catherine Falconer and Sophie George

Purpose of the paper

The purpose of the paper is to outline UKHSA’s approach to targeting people and places at most risk from health security hazards and highlight the development of the cross-organisational 2023-2026 Delivering Health Equity for Health Security strategy, following extensive engagement across the organisation and with key partners.

Recommendation

The Advisory Board is asked to:

• note the importance of identifying, monitoring, and addressing the needs of people and places at most risk from external hazards to health to achieve more equitable outcomes and improve health security for all
• note the proposed approach to retain the strategy as an internal document and publish a ‘CORE20PLUS’ Framework following the publication of the UKHSA strategic plan
• comment on the approach outlined in the 2023-2026 Delivering Health Equity for Health Security Strategy
• comment on the scale of the ambition described and work underway to deliver on the strategy and milestones outlined in the strategic action plan

Background

There are considerable differences between communities and groups in society in terms of their risk of exposure to a health hazard, their susceptibility to poor outcomes when exposed, and their capacity to be resilient against these threats.

To realise the UKHSA mission to provide health security to the nation, we need to identify and monitor the individuals and communities at highest risk to inform action. Doing this will enable UKHSA to achieve its core commitment to ‘achieve more equitable outcomes’ and will support the organisation to deliver value for money and meet our legal duties to pay due regard to tackling health inequalities and to the Public Sector Equality Duty.

To achieve more equitable health security outcomes, the health system must work together across national, regional, and local levels. We have engaged with The Department of Health and Social Care – including the Office for Health Improvement and Disparities (OHID); NHS England; and OHID regional teams, to develop our approach. We continue to work closely with them in the delivery of health protection services, for example, managing the current outbreak of diphtheria in the asylum seeker population. Our science and data capabilities and insights contribute to the work of NHSE and OHID, while focusing on improving health security for all.

Strategic case for change

UKHSA will best achieve its mission by combining broad population level approaches alongside a range of tailored models to prepare, respond, and build health security capability and capacity where the risk is highest. Understanding the burden of disease in specific population groups and settings; and co-creating interventions to meet specific needs, will allow UKHSA to do this.

Providing access to cost-effective interventions, such as vaccination, or testing and early treatment of TB and Hepatitis C, for vulnerable population groups, can prevent the emergence of more serious and costly health security threats and protect people from avoidable ill-health and mortality. Targeting UKHSA’s resources on at-risk groups not only improves efficiency but contributes to the cost savings associated with control and elimination targets.

Data is not always routinely collected or made available to identify and address vulnerability, and those at highest risk are often invisible in routine surveillance outputs. UKHSA is still at an early stage of organisational maturity. Insights from the development of this strategy show that current approaches to data, partnerships, and ways of working constrain UKHSA’s ability to take a risk-based approach.

Strategy development

The Executive Committee approved an approach to developing the Delivering Health Equity for Health Security Strategy in August 2022. The strategy and accompanying plan have then been developed through an iterative process with representatives from across the organisation, including a cross-organisational task and finish group.

The strategy has been developed in parallel with UKHSA’s draft three-year strategic plan. We have had regular, active engagement with the Strategy team throughout the strategy development, ensuring it supports UKHSA’s strategic framework and goals to Prepare; Respond; and Build. This close alignment enables the strategy to advance a unified approach to heath equity for health security across the organisation whilst the UKHSA strategic plan is finalised.

The strategy development process has been overseen by the UKHSA Health Equity Programme Board, led by the Director for Health Equity and Clinical Governance (chair) and Director for Health Protection Policy (vice chair), and with which has cross-organisational senior representation. The Equalities Ethics and Communities Committee has provided constructive challenge and support its ambitions.

UKHSA has also consulted with our system partners at national and regional levels including NHSE and OHID. Partners have welcomed the development of the strategy and its focus within UKHSA’s areas of remit.

In February 2023, the Executive Committee agreed to the approach outlined in the strategy and recommended further engagement with groups across UKHSA. Subsequently, every group senior leadership team has now received a presentation on the strategy, resulting in broad commitment to developing and delivering the strategy and accompanying action plan.

The Delivering Health Equity for Health Security strategy requires a distributed leadership model with action taken across, and at every level of the organisation if it is to be successful. The development process and engagement in events such as ‘UKHSA Live’ has supported this by raising awareness of the importance of health equity to UKHSA’s mission. This has led to the identification of opportunities to leverage existing work to further deliver on the strategy. However, ongoing prioritisation of funding for activities will be required to achieve population level impact.

Strategy overview

The ‘Delivering Health Equity for Health Security’ strategy sets out an approach to identify and target people and places at most risk to reduce avoidable harm and improve health security outcomes for all. This includes strengthening our organisational capability to prevent or mitigate the disproportionate impact experienced by people and places at highest risk and improving how we respond to health security incidents in a way that enables vulnerability to be identified and addressed.

The strategy outlines four areas of strategic focus to create an enabling environment. By prioritising these in year 1, the organisation will have the foundation it needs to start to set and deliver demonstrable change and impact. These areas of focus are:

• building scientific and data knowledge and capability
• taking a ‘people and place’ approach
• advancing equitable health security through partnership approaches; and
• creating a culture where our workforce understands our legal responsibilities and have the capacity and capability to achieve more equitable health security outcomes

To support alignment with the wider system, UKHSA has adopted NHS England’s CORE20PLUS framework to identify the populations we will routinely consider in our work. This includes the most deprived 20% as identified by the national Index of Multiple Deprivation (IMD); people with a protected characteristic; people experiencing geographic inequalities; and inclusion health groups. Based on our experience of COVID-19, we have also included reference to people with clinical vulnerabilities. The populations considered as part of this framework will be adapted to reflect UKHSA’s health security focus and enable flexibility for the specific context.

The framework will be added to with a set of population level outcomes for CORE20PLUS groups and published externally following the launch of the UKHSA strategic plan. The framework will be developed through a series of cross organisational ‘people and place’ workshops to review data and evidence on vulnerability and burden of disease; agree on population level outcomes (for example, TB elimination targets) for CORE20PLUS groups; and set the additional outputs and actions to achieve these.

While further data and science knowledge and capability is built and the CORE20PLUS framework developed, actions will focus on a small number of selected populations and places known to be at highest risk and identified by consensus at the HE Board: prisons and places of detention; vulnerable migrants; people experiencing homelessness; and place-based inequality. This is in addition to a continued focus on deprivation and ethnicity.

Delivery of the strategy

The strategic action plan, which is an internal document, sets out how the strategy will be delivered and monitored in year 1. The Health Equity Board will continue to provide oversight, in line with UKHSA’s governance processes.

To meet the Department for Health and Social Care’s requirements and our statutory duties, UKHSA will continue to report progress to tackle health inequalities and deliver against the Public Sector Equality Duty (PSED) objectives.

Examples of the actions already taken to achieve year 1 milestones and create an enabling environment include:

Building science and data knowledge and capability for CORE20PLUS

Ambitions are incorporated in UKHSA’s science and data strategies. UKHSA’s data maturity assessment work, delivered as part of the data strategy will include objectives to improve our understanding of disproportionate impact. Evidence and insight on priority population groups will be collected into a shared repository. A year 1 ambition is to deliver an externally published technical report on health equity in health security to coincide with the UKHSA conference in November.

Taking a people and place approach

We are strengthening understanding of the interventions that can effectively prepare, respond, and build in priority population groups, recognising the key contribution of our regional health protection teams. This has included commissioning research to understand experiences of priority populations across a range of health hazards; and generating learning and best practice through regional networks. In year 1 we will deliver at least two proof of concept projects, including innovative approaches to winter planning, and testing the feasibility and effectiveness of a whole prison flu vaccination pilot.

Advancing equitable health security through partnership approaches

UKHSA has started to build strong relationships with health agencies, other government departments, regional partners and the public. This has included contributing to the development of the NHSE Inclusion Health Framework for integrated care systems and jointly commissioning a project through the Health and Wellbeing Alliance with NHSE and OHID. In year 1 we will deliver an engagement framework outlining how we will engage with communities and groups at highest risk.

Creating a culture where health equity is prioritised

UKHSA has taken action to improve the diversity of the workforce including through the launch of the ‘Accelerate’ career development programme. The incorporation of prompts into existing processes such as the 2023/24 business planning cycle has supported the workforce to consider their role in contributing to more equitable health security outcomes. In year 1, we will develop a comprehensive training and tools package on health equity for UKHSA. Data will continue to be provided to teams to assess and improve the diversity of the workforce.

Next steps

We plan to use the strategy as an internal document and share with the key partners who have contributed to the development process.

The CORE20PLUS framework will be developed following the publication of the UKHSA Strategic plan. The framework will be published, enabling collaboration with partners across national and regional levels.

Following the first year of implementation, we will update the Advisory Board on progress against the milestones and development of population level outcomes. In the meantime, we will continue to work towards the milestones outlined in the strategy and provide regular updates to the Executive Committee through the Health Equity Board, and to the Advisory Board through the UKHSA Equalities Ethics and Communities committee.

Amy Jackson and Jodie Cuff
Public Health Manager (CPH); Policy Manager (SPP)
May 2023