Agenda item

Ansaf Azhar has been invited to present a report on Oxfordshire becoming a Marmot Place.

This is an opportunity for the Committee and the wider public to receive further insight into the work and progress to date on Oxfordshire becoming a Marmot Place.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Ansaf Azhar, Director of Public Health, and Kate Holburn, Deputy Director of Public Health, introduced the Marmot Place report and were prepared to answer questions the Committee had about the process of Marmotisation and its potential impact on Oxfordshire.

The Director of Public Health highlighted health disparities in Oxfordshire, despite its affluence, and recommended the Marmot Place initiative's system-wide approach. This initiative provided a framework for improvement, inspired by Coventry's positive results. The Deputy Director discussed using data and community engagement to address local inequalities, focusing on children's welfare, fair employment, and healthy living standards. She described the governance structure, work streams, and projects like children's services pathways, housing health assessments, and rural inequality mapping, while mentioning collaborations with universities and community engagement plans.

The Committee asked why three out of eight Marmot principles had been selected. The Deputy Director of Public Health explained these principles aligned with ongoing local work and provided a defined focus. This strategy allowed for measurable results and adhered to the Health and Wellbeing Strategy. Although the Institute of Health Equity recommended focusing on two principles, Oxfordshire selected three due to existing initiatives. These principles interconnected with others for a comprehensive approach.

Members queried if the Marmot Place initiative would involve local councils, parishes, and villages. The Director of Public Health confirmed it would, leveraging their knowledge and projects. The engagement process incorporated Committee input, ensuring thorough involvement. The Marmot team offered independent expertise to enhance initiatives and identify areas for improvement.

Members enquired if resources would assist rural groups in gathering data for the Marmot Place initiative. The Deputy Director of Public Health confirmed support for these groups, involving voluntary organisations to collect evidence through surveys, discussions, and focus groups. The Director of Public Health emphasised the need for both quantitative and qualitative data, including community insights, to address rural inequalities.

Members inquired about how rural inequalities were quantified. The Deputy Director of Public Health explained that census measures focused on household-level deprivation across employment, education, health and disability, and household overcrowding. The Director mentioned that qualitative aspects like social isolation and community insights were vital. The initiative included community engagement and lived experiences.

The Committee asked about the prevention of increasing inequalities and the measurement of intervention success. The Director noted that a hierarchy of evidence was used, including community feedback and randomised control trials, but ethical issues prevented control groups without intervention. Instead, a mix of qualitative and quantitative evaluations, including Policy Lab research, assessed intervention effectiveness.

Members enquired about collaboration and coproduction efforts, particularly with Oxford universities, and inclusive examples of patient and public involvement. The Director of Public Health and the Deputy Director of Public Health clarified that coproduction in the Marmot initiative involved community health development officers, focus groups, and partnerships with organisations such as Healthwatch. The engagement process was iterative and adapted to different communities. Regarding Oxford University Collaboration, the Policy Lab—a collaboration with Oxford University and Oxford Brookes University—was a significant component of the initiative, involving students in real-time research projects addressing local policy issues, including health inequalities.

Members inquired about the governance and accountability of the Marmot initiative, particularly regarding the public availability of minutes from the Marmot Advisory Board and steering group meetings, and local governance involvement. The initiative was accountable to the Health and Wellbeing Board, ensuring transparency through structures like the Marmot Advisory Board, led by Michael Marmot, and a steering group with representatives from various organisations. Local projects reported to existing governance frameworks, integrating within systems like Children and Young Person's governance.

The integrated care strategy aligned health strategies within the ICB footprint, focusing on managing long-term conditions and addressing health determinants. Discussions included integrating broader health policies with the NHS 10-year plan and potential combined or mayoral authorities, emphasising regional collaboration with public health directors.

To evaluate success, the initiative aligned with existing health strategy indicators, monitored over time for progress. Specific indicators for Marmot-aligned projects tracked short-term proxy indicators for early insights and qualitative evaluations to capture the impact on communities and recognise contributions from the voluntary sector.

The Committee AGREED to the following recommendations subject to potential minor amendments offline:

1. To ensure that there is sufficient transparency around the steps being taken as well as the impacts being achieved around Oxfordshire becoming a Marmot Place. It is recommended that there is a development of specific indicators for the purposes of evaluating collective system-level efforts to achieve this.​

2. To explore further avenues of funding for the purposes of supporting the work to making Oxfordshire a Marmot Place. 

3. That specific indicators are developed for rural inequalities, inviting input from Town and Parish councils and local members who can contribute local knowledge of inequalities. It is also recommended that there is support for recognition of existing projects and voluntary and local community organisations (who can act locally) that are tackling these inequalities.