Agenda item - Reducing Health Inequalities in Brighton & Hove

NHS Sussex and Director of Public Health report (copy attached).

25.1              The item was introduced by Tanya Brown-Griffith, NHS Sussex Director for Joint Commissioning and Integrated Community Teams (Brighton & Hove); Joanne Alner, NHS Sussex Director of Population Health and Inequalities; Steve Hook, City Council Director of Adult Social Services; and Dr Nicola Lang, Brighton & Hove Director of Public Health.

25.2    Ms Brown-Griffith told the committee that reducing local health inequalities was at the heart of improving the city’s health. Brighton & Hove has stark health inequalities, with significant areas of deprivation, high unemployment rates, housing insecurity and mental health issues. With limited capacity, support will be targeted at those individuals and communities in the greatest need.

25.3    Dr Lang told the committee that there is increasingly good data on population health in Brighton & Hove, including the latest (2025) Index of Multiple Deprivation, the Safe & Well in Schools survey and the Health Counts survey. Of particular note are the obvious impact on health of ‘wider determinants’ such as housing and education and training. There has also been a significant fall in female healthy life expectancy in recent years, coupled with increasingly high rates of mortality for women in ‘inclusion health groups’. Long term conditions are especially prevalent in the most deprived areas of the city.

25.4    Ms Alner told members that the local fall in women’s healthy life expectancy mirrors a negative trend both nationally and at a Sussex level. The continuing impacts of Covid and of the cost of living crisis are factors in this but there are also particular local issues around high rates of ‘external causes of mortality’ including suicide and drugs and alcohol misuse. There is lots of good integrated working already happening via Integrated Community Teams (ICT) and the pilot work undertaken around supporting people with multiple compound needs. More work needs to be done to capture data from some communities, included disabled people and middle-aged men.

25.5    Cllr Simon asked why there is no health hub in Woodingdean despite its high levels of need. Ms Brown-Griffith responded that taking different approaches to different areas is a key part of the neighbourhood health approach. There are a wide range of community services available for Woodingdean residents even though there is no physical health hub.

25.6    Mary Davies (Older People’s Council: OPC) commented that the report would have been more accessible if written using less professional terminology. She also asked whether ageing well services were being adequately advertised. Ms Brown-Griffith replied that ageing well services are widely advertised in community and religious spaces, but services would reflect on what more can be done. Dr Lang also offered to meet separately with the OPC to address their concerns.

25.7    Cllr Parrott noted the reliance on Voluntary & Community Sector (VCS) organisations in neighbourhood health plans and queried how achievable this ambition was given inconsistency of funding for the sector. Mr Hook replied that the VCS is a vital partner as they are much closer to communities than are statutory services, hence the close working with organisations such as the Hangleton & Knoll Project and the Trust for Developing Communities. Ms Brown-Griffith added that commissioners recognise the vulnerability in some areas of the sector and with the Local Authorities commission VCSE infrastructure organisations and a Sussex VCSE Leaders Alliance to be a strategic ICB partner.

25.8    Cllr Evans said that she supported the principles of neighbourhood health. However, there was an anomaly here: Wellsbourne Health CIC was a model community GP practice. Since taking on the Whitehawk GP contract it had doubled the patient list and achieved or overachieved its performance targets as well as increasing vaccination rates and building real trust with the local community and local VCS. However, none of these achievements had protected it from commissioners putting its APMS contract out to tender. It makes no sense to be pushing a neighbourhood health agenda at the same time as destabilising organisations that already deliver effective neighbourhood health. Ms Brown-Griffith responded, noting that there is an ongoing review of the procurement of the APMS contract which precluded her addressing specific points.

25.9    Cllr Ladermacher asked what measures were being taken to acknowledge and address unmet needs of neurodiverse people. Dr Lang replied that this is an issue that is acknowledged; more work needs doing by partners to address unmet need. Mr Hook added that the Autism Partnership Board does some excellent work in this sphere.

25.10  Cllr Mackey asked a question about mental health support for older people. Ms Brown-Griffith agreed to share some information on this at a future meeting as there was ongoing community Mental Health and Wellbeing services to improve provision including for older persons.

25.11  Cllr Mackey asked about malnutrition and its links with increasing hospital admissions and length of stay. Ms Brown-Griffith noted that there are commissioned services for eating disorders and for malnutrition in older vulnerable adults. Ms Alner added that there is monitoring of births to assess birth weights of babies. However, while malnutrition may not be a major driver of health inequality, obesity definitely is and there is a major focus on this.

25.12  Nora Mzaoui (VCS representative) asked about access to open space and exercise. Dr Lang responded that Brighton & Hove is already very physically active. There is lots of targeted support to encourage physical activity in certain communities.

25.13  Cllr Winder asked how all the positive neighbourhood health activity would be coordinated. Dr Lang responded that key to this would be the refresh of the city Joint Health & Wellbeing Strategy. The Strategy refresh will be a co-production across partners including VCSE as community and patient voice leaders. Ms Brown-Griffith added that feedback/insights from communities would be captured to monitor neighbourhood health.  

25.14  Cllr Parrott asked how the seafront is covered. There are pockets of deprivation across the city, many of which are not covered by the current health hubs. Ms Brown-Griffith replied that we are in the early stages of the roll-out of neighbourhood health. The initial focus for community health hubs and satellite hubs is East and Central localities driven by data, the work of the ICT Leadership Groups within current resource. This is expected to scale and expand to meet population need starting with the areas of the city with the worst deprivation and health outcomes.

25.15  The Chair noted that it would be important for the committee to be regularly informed on the progress of this important initiative, and particularly as to whether additional activity was leading to a narrowing of the health inequality gap. He asked for a report back in 12 months’ time. Which should include trend data.

25.16  RESOLVED – that the report be noted.