By Dr Linda Charles-Ozuzu, Regional Director of Commissioning, NHS England and NHS Improvement – North West

The need to tackle health inequalities has never been more urgent. COVID-19 has amplified the unacceptable, unjust and avoidable differences in people’s health across our population and between population groups.

Yet even now, many people are not aware of its toll on vulnerable groups. We have all heard about the tragically high number of deaths in care homes, but how many know about the 134% increase in deaths of people with a learning disability over five weeks this year, reported by the Care Quality Commission?

We know about the link between COVID – 19 and long-term conditions such as diabetes and high blood pressure, but how many have realised that people who are homeless are at higher risk of these health conditions? Research by the UCL Institute of Health Informatics found people who are homeless were twice as likely to die of strokes as the poorest people who had housing, and were also more significantly affected by cardiovascular disease.

COVID – 19 has also shone a spotlight on the living conditions of many of our society’s key workers. Poorly paid people, often of Black, Asian and minority ethnicity, living in cramped conditions, with the increased risk of long term health conditions associated with deprivation, yet going out day after day to help others in their frontline roles in transport, retail, and health and care services.

As National Voices has said in its Five Principles for the Next Phase of the COVID-19 Response, we’re all in the same storm but we’re not all in the same boat.

That’s why in the North West region, the NHS and local authority partners have been prioritising development of a COVID-19 Community Risk Reduction Framework. This is in line with the national phase 3 letter and phase 3 follow-up,

It identifies key ways of working and specific steps that partnerships at local, town/city and regional level can take to proactively reach out to and protect the people at highest risk. This is particularly important in our area, which has some of the greatest health inequalities in the country.

Immediate collective priority actions focus on four groups: people of Black, Asian and minority ethnicity, people with a learning disability, people living in socioeconomic deprivation, and inclusion health groups (particularly homeless people and offenders).

It is all about using data, insight and local intelligence, combined with real knowledge of and relationships with communities, to target interventions now and mitigate the risks of a potential second wave of COVID – 19.

The aim is for those council wards and individuals at greatest risk from COVID – 19 to be identified and offered urgent support through coordinated work between GPs, health and care colleagues, Directors of Public Health and their teams, and the voluntary sector.

A shared Community of Practice for the North West region, supported by an interactive online platform, supports this work, enabling collaboration, sharing of key documents and learning, and problem solving.

And the absolutely key thing is that this urgent effort to protect the people at highest risk is delivered through work with the communities themselves.

Community champions and influencers are a vital part of supporting the successful delivery of culturally competent health promotion and disease prevention approaches to ensure their local populations get the interventions they need.

This will be backed up by a major community experience initiative getting underway in the North West to hear the voices of communities that have been disproportionately affected by COVID-19.

It will start with people who were homeless when the pandemic struck and hear how things developed for them, as they came in off the streets. Their stories will help to shape the future planning and delivery of services.

The aim is to expand this so that the voices of all those communities which have suffered as the result of systemic health inequalities during the pandemic are heard – and to ensure this brings about lasting change.