Sheffield Health and Social Care by ajizai

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									Sheffield Health and Social Care – Tackling Health Inequalities

– Submission to the Sheffield Fairness Commission


Sheffield Health and Social Care (SHSC)
SHSC are an NHS Foundation Trust which provides mental health, learning disability, substance misuse,
community rehabilitation and primary care services to the people of Sheffield. We also provide some of our
specialist services to the wider region.


1.     What specific evidence do you hold about inequalities and fairness that may be of use to the
       Commission?

       There is a range of data and information available nationally and locally on health inequalities
       experienced by people who use our services who may experience inequalities, this includes data on:

        –   Inequalities experience by people with learning disabilities
        –   Inequalities experienced by people with mental health conditions
        –   Inequalities experienced by people from Gypsy and Traveller communities
        –   Inequalities experienced by people with drug or alcohol problems.
        –   Inequalities exacerbated by or associated with ageing
        –   Inequality experienced by carers of people who use our services including young carers
        –   asylum seekers and refugees

       These inequalities may be associated with or exacerbated by the following areas for some or all
       groups again there is national evidence available; financial exclusion, housing issues, stigma,
       employment, smoking prevalence, accessibility of general health services to the group, assumptions
       (e.g. the perceived ability of people to give up smoking) , gender inequalities , inequalities associated
       with ethnicity.

       There is a wide range of national evidence some of which has been considered locally, for example,
       data on employment and mental health.

       The Trusts has data on use of services by the above groups which can be broken down across a
       range of demographics.

       Anecdotal evidence suggests that national programmes such as the work programme may not be
       beneficial and may particularly disadvantage people with complex long term problems.


       Specific evidence we would also draw attention to is:

           Of the total life years lost to disability and premature death 45% results from mental health and
            neuropsychiatric conditions, while only 10% of the NHS budget is spent on mental health.

           People with serious mental disorders such as schizophrenia and bipolar disorder die 20 years
            younger than other people.

           People in BME groups are 6 times more likely to be subject to the mental health act provisions.

           23% of the population have a diagnosable mental health condition but one fifth get help for this.

           75% of people who commit suicide in Sheffield had not been in contact with mental health
            services but 90% had seen a GP in the month before the suicide.




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        Specific to older people: the FMI Strategy document which is being refreshed acknowledges a
         significant gap in equal access to psychological therapies in wards Community Mental Health
         Teams and specialist, crisis resolution and home treatment and substance misuse services.
         Work has been done to address these within existing resources (e.g. acute care reconfiguration,
         FICS) but some of the lack of equity is due to a 65 cut off for some commissioned services or
         indirect discrimination such as access to buildings or home based IAPT availability for physically
         frail people.


2.   Based on your evidence what is your or your organisation’s analysis of the cause/s of
     inequalities within Sheffield?

     –   Commissioning of services: inequality in per head of population spend on physical health care
         compared to mental illness, it is far greater for the former

     –   Here in Sheffield we still commission for physical secondary hospital based health care at the
         expense of commissioning for community health care for all care groups including MH & LD

     –   The physical health care of people with mental health problems needs to be radically rethought


3.   Are there any examples of good practice in relation to reducing inequalities and increasing
     fairness (from within the city, elsewhere in the UK, or overseas) that the Commission should
     be aware of?

     –   Local - The action generated through the local area agreement focused on PSA 16
         (employment and mental health and employment and learning disability) is an example of joint
         working focused on a specific area of inequality. The value is not only in measurable outcomes
         but also in areas such as improvement in joint working, knowledge generation and maximising
         use of resources.

     –   Local – SHSC has developed a specific ‘Employment Strategy’ for service users, this has
         resulted in a range of positive outcomes.

     –   Local - Joint working on housing and accommodation has also taken place involving
         commissioners and service providers looking at strategic issues such as housing provision for
         vulnerable groups and considering areas such as barriers to accessing accommodation. SHSC
         and SCC jointly appointed a housing and mental health worker based in Housing Solutions.

     –   Local - The mental health CAB provides easy access to advice on a range of areas such as
         finance to people using mental health inpatient services.

     –   Local - A pilot project completed in partnership with the Debt Support Unit provided one to one
         debt support in mental health community services – this project led to considerable amounts of
         personal debt being identified which had not previously been discussed with Trust staff.

     –   National - The Institute of Health Equity have produced a draft report which they are running a
         consultation on, the report titled - The role of the health workforce in tackling health inequalities
         - explores actions the Health Workforce can take to positively influence the social determinants
         of health and tackle health inequalities.


4.   What do you or your organisation believe would be the best way to tackle inequalities and
     increase fairness in the city?

     –   There is inequality in the population based needs assessment for the city – the JSNA does not
         adequately address the needs of the city’s population with Mental ill health or at risk of mental ill
         health thus commissioning does not reflect a true understanding of need & provision is based
         on historical activity & is subject to cuts at a greater proportion than general hospital services.

     –   Joint working can result in barriers being identified and targeted action, joint working can also
         lead to more efficient use of organisational resources.

     –   We think there should be more of a focus on wellbeing


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        –   We believe that asking people what makes a difference for them is beneficial i.e. co –
            production.


5.     What should be the top 3 priorities for the city?

       The basis of health inequality is fundamentally rooted in economics, so the poorer you are the less
       good health you have (& vice versa) most people with long term mental ill health are unemployed,
       therefore are economically at a disadvantage and likely as a result to have worse overall health - the
       ‘foresight’ work & ‘marmot report’ all acknowledge this.


       Top priorities:

       1.   Joint Commissioning between Health & the Local authority for example through health and
            wellbeing board and a comprehensive population based needs assessment should underpin
            commissioning for MH (currently it does not) & LDS, significant improvement required in the
            quality of commissioning for MH in particular.

       2.   Transparent analysis of where the greatest overall health gain can be made from spending
            public money for the city (need to think longer term too) prevention, earlier intervention in
            schools & the education system etc. Public Mental Health – a focus on wellbeing a priority for
            Sheffield & everyone’s business not simply seen as the remit of the NHS (SHSC specialist
            service) so requires a fundamental shift across the city in approach to public sector
            commissioning & provision to address persistent inequalities.

       3.   Need to move health and social care closer to primary care – see for example data on suicide
            and physical health above (75% of people who commit suicide in Sheffield had not been in
            contact with mental health services but 90% had seen a GP in the month before the suicide,
            People with serious mental disorders such as schizophrenia and bipolar disorder die 20years
            younger than other people)




Author: Liz Johnson
April 2012




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