Some people are more vulnerable to poor health than others. Evidence suggests that some groups and communities within Wakefield District have a greater vulnerability to poor health. This arises from the combined effects of deprivation on health with the fact that some groups find services difficult to access.
This comprehensive and overarching section of the Wakefield Joint Strategic Needs Assessment brings together all of the existing intelligence on the health and wellbeing needs of vulnerable groups. The information in this report has been gathered from a variety of national and local sources, including the Office of National Statistic (ONS), Government Departments, local Council, NHS, the Voluntary Sector information and brings together all the information available from the various local Health Needs Assessments
It attempts to begin to define ‘vulnerability’ to poor health and how we may include this in our commissioning plans, and by bringing together all our information and intelligence on Vulnerable Groups, we have the beginnings of a joined up and informed approach to really tackling the needs of the most vulnerable in our District.
Whilst there is no separate guidance as to how a Vulnerable Groups JSNA should be undertaken, this review has followed the spirit of the overall guidance and applied this to Vulnerable Groups. The full report can be read by clicking the link in the resources section of this page.
What do we mean by ‘vulnerability’?
Vulnerability is fluid as it may depend on circumstances and can change through time or a particular set of environmental circumstances. It is more to do with a mixture of characteristics and conditions which increases susceptibility to poorer health and difficulty accessing services. People who are vulnerable often experience multiple, complex problems and enduring disadvantage.
A definition of vulnerability could be described as a matrix. It is the combination of vulnerable characteristics rather than one in isolation that produces the vulnerability leading to poor health and wellbeing outcomes.
We therefore need a more sophisticated way of tackling vulnerability. Targeting a whole vulnerable group or a whole geographical area is not sufficient to ensure we have a positive impact on the people with the greatest health need. The less vulnerable will usually find services easier to access. Just targeting groups can also lead to victim blaming and focusing on the symptoms of vulnerability. Focusing on the reasons for the causes of vulnerability and ensuring the whole health and social care system provides equitable care will be the most effective ways of reducing inequalities in health.
Why is it an issue?
The Cabinet Office and the Department of Health have both published documents which provide a clear message – there is a strong case for change to improve the poor health experienced by socially excluded people. The case is made not only on the grounds of social justice, but also because of the financial costs if we do nothing. People who are more socially excluded are more likely to make chaotic and disproportionate use of health and social care services.
The health needs of vulnerable groups are often complex and require a coordinated and flexible response from services. It is easy for clients to fall between the gaps of different services leading to unplanned care and clients revolving through the system.
We need to get better at looking in a more sophisticated way at vulnerability and the context in which some groups may be more vulnerable and the vulnerable sub-groups within vulnerable groups; e.g. the South Asian woman from a BAME group who is also learning disabled, rather than just focusing on BAME groups in a generic way. Targeting a whole vulnerable group or a whole geographical area is not sophisticated enough to ensure we have a positive impact on the people with the greatest health need as the less vulnerable will usually find services easier to access.
Recent local insights into those with Autism is available here
The housing need of those with Learning Disabilities is available here
What needs to happen to effect a change?
- Generic services are designed in such a way that recognises vulnerability; Commissioners and providers of health and social care need to identify how their services could be reviewed to improve accessibility by the most vulnerable and deliver the services proportionately to need.
- Greater utilisation of Equality Impact Assessments and health equity audit as a tool to ensure services are delivering equitable outcomes.
- All service specifications include equality monitoring requirements.
- Service evaluations are designed so that they are sensitive to reflect the needs of vulnerable groups.
- Support is given to commission a programme of Health Needs Assessments which will meet the identified intelligence deficits outlined.
- Maximise Community engagement in Health Needs Assessments process by utilising different methodologies e.g. Participatory Appraisal Approach.
- The Vulnerable Groups chapter of the Wakefield JSNA is kept up to date as a “live” document.
- Foster a greater understanding and awareness of cultural and religious factors and also discrimination which affect the health of specific minority groups.
- Improve equality data to ensure positive health outcomes for Vulnerable Groups.
- Consider how we can establish a “read” code for vulnerability for primary care.