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Community, services and policy: A three-pronged approach

Nottingham City Council published a BAME Inequalities Framework in the summer of 2020 which set out a place-based approach to trying to make progress. A taskforce, including representatives from the council and other public sector partners and community groups, was set up to help drive forward the work, including around COVID-19 vaccinations. This case study forms part of the health inequalities hub.

The pandemic has given added impetus to Nottingham City Council’s push to tackle health inequalities. A BAME inequalities framework was published in 2020 setting out a new strategy to address the issue. It focuses on three core themes – the community, services and policy. 

The framework has prompted a range of new initiatives, including a data-driven approach to driving up COVD-19 vaccination rates and new incentives for GPs to carry out health checks among ethnic minority groups.  

‘Pandemic has strengthened our determination’ 

Around three in 10 people living in Nottingham are from ethnic minority groups. Prior to the pandemic, the council had a range of policies and procedures in places to address health inequalities.  

These included an in-house inequalities board to consider workforce issues, while certain services, including smoking cessation and weight management support, were contractually incentivised to target people from ethnic minority groups. 

But the pandemic has given the drive added impetus. The summer of 2020 saw a BAME Inequalities Framework published. It set out a place-based approach to tackling the issue. 

The framework is built around three domains: 

  • The community – building on local assets such as volunteers, social networks, and charity, faith and community groups. 
  • Services – ensuring services engage, consult and strive to become culturally appropriate. Leisure and culture, social care, education and public health identified as key services. 
  • Policy – recognising the importance in approaches to policy, such as the urban environment, including access to green spaces and planning of fast food outlets, affordability of housing and fuel poverty 

A taskforce, including representatives from the council and other public sector partners and community groups, has subsequently been set up to help drive forward the work. 

Public Health Consultant Dr David Johns said: “As the pandemic progressed, it became clear ethnic minority groups were disproportionately affected and that strengthened our determination to tackle the issue. The framework was published to set out a clear strategy to guide the work we wanted to do.” 

Targeted approach to improve COVD-19 vaccine uptake 

The principles set out in the framework were immediately applied to the rollout of the COVID-19 vaccination programme. 

A vaccination bus had toured local areas where uptake was low, while pop-up vaccination clinics were run in faith settings and community leaders recruited to champion vaccination. Like many areas, Nottingham made good progress but there were still significant differences in uptake between different ethnic groups. 

So during the summer of 2021 Nottingham worked hard to understand more about the differences in uptake. They analysed GP records to break different ethnic groups into smaller, more identifiable groups. 

Inequalities Lead Jade Farrell, who is leading the work on COVID-19 vaccination uptake, said: “The COVID-19 vaccination data was providing very broad ethnicity groups which meant it was hard to focus our vaccination work on specific communities.

“By analysing data, we found the worst take up rates were focussed in the Arab and Chinese communities. There was also a markedly lower rate of vaccination in the Black Caribbean community compared to other Black groups. It means we have really started being able to target these communities that have the lowest rates. 

For example, we have been offering live COVID-19 vaccination Q&A sessions to our local residents through the city's African and Caribbean community radio station.

“It is a slow, gradual process. You have to listen to the communities’ concerns, engage with local residents and leaders conversation by conversation, building the trust of the community. Having the relevant data and targeting specific communities allows us to work with the lowest uptake groups to make a difference.”

A long-term approach to health inequalities 

The work on improving vaccine uptake is just one part of Nottingham’s drive on health inequalities, said Dr Johns. “The pandemic meant we have been firefighting really over the past year, focussing on COVID-19 and the fallout from that. But we do want to look more broadly at what can be done – the framework is really to guide our thinking over the next five to 10 years of work.

Addressing health inequalities is not going to happen overnight and it needs to involve a wide-ranging and comprehensive approach. Progress is starting to be made in other areas. 

One development has seen enhanced payments given to GPs to prioritise health checks for ethnic minority groups. Meanwhile, an equality, diversity and inclusion maturity matrix is also being developed for the integrated care partnership to allow partners to assess their approach in the way they commission services.

And councillors have set up their own working group to address health inequalities and are in the process of carrying out their own review into the issue.  

In the community a series of workshops have started being held as part of an asset mapping exercise to identify what BAME networks, groups and organisations exist.

Dr Johns added: “Our neighbourhood teams have always worked closely with the community and voluntary sector, but during the pandemic we have become aware of many new groups and individuals. We want to help support them. 

“There isn’t always funding, but we can help them in other ways, such as making the data and tools they need to prepare bids for grants for elsewhere and helping strengthen the links in the community to help them thrive.”