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Amy Gibbs, Chair of Tower Hamlets Together - February Briefing

Posted on: 19 February 2021

We didn't meet as a Board in January due to the urgent Covidcrisis at that time, so if it isn't too odd to say, I wish everyone a safe, healthy, and more hopeful 2021. February's THT Exec Board was only an hour, but we managed to cover two crucial issues in-depth -trauma-informed care and Covidvaccinations.

We opened with a powerful and practical presentation about trauma-informed care, from Mina -an expert experience-and Myrto -a complex trauma psychologist from ELFT. This discussion has been on the Board's forward plan for some time but feels highly relevant as we try to rebuild from the pandemic. Rather than focusing on particular labels or diagnoses, trauma-informed care recognises the impact of adversity on individuals and at its core is about treating people as human beings with engagement and interactions that respect their specific histories. Whilst the presentation was from ELFT, there was a clear message that trauma-informed care can be relevant for many people at any "front door" across the THT system.

Mina shared how the approach recognises that trauma is rooted in the abuse of power, so it moves health and care services away from paternalistic approaches. It also acknowledges the systemic causes of trauma e.g. structural racism, misogyny, heterosexuality, and ableism. For example, as trauma is defined as either one event or repeated exposure, persistent racist microaggressions can have a "snowball effect" on trauma for people of colour. Given the significant disparities in Covid-19 serious illness and deaths among Black, Brown, and disabled people, trauma-informed care could be an essential part of how we recognise and respond to collective and individual trauma moving forward.

In practical terms, trauma-informed care looks like keeping proper records, so people are not forced to repeatedly tell their stories; timing calls or appointments sensitively, for example not phoning someone to ask about their experiences of suicide first thing in the morning; genuine collaboration and autonomy with patients and service users. Board members were unanimous in wanting to adopt trauma-informed care at both strategic and practical levels -from a wider partnership commitment to being a "trauma-informed place", to asking services to roll out the practical framework and steps to their teams. We also reflected on its relevance for the workforce in order to support staff wellbeing, given the significant levels of trauma experienced by frontline workers in all partners.

The second item was the Covid-19 response, specifically the vaccination rollout. The GP Care Group reported that despite initial issues with data and ongoing lags in information, locally we are now getting to the cusp of priority groups 1-4, so are focused on persuading people who are eligible to attend and are about to move to offer the vaccine to 65+. There's been a significant partnership effort more recently -for example, the council and GP Care Group working together to set up the vaccination helpline, and the London Muslim Centre setting up vaccine clinics at the East London Mosque.

Board members had questions about the uptake of vaccinations from different population groups -we heard that Tower Hamlets is not an outlier in seeing a lower proportion of people from Black, Asian and other ethnic groups in general. Birmingham has been flagged as an area of good practice but we must also avoid making broad brush comparisons, given the different populations that tend to be unhelpfully grouped together as "BAME". We reflected about the negative connotations of terms like "vaccine hesitancy" which imply fault on the part of the community, mask the complexity of the issues, and fail to acknowledge structural and historic reasons why there may be mistrust in the health and care system. Equally, there are significant differences between ethnicities and "Asians" are not one group. Some of the "hesitancy" has also been due to practical reasons like place -some of the vaccine sites (chosen centrally) have not been the most accessible especially for olderpeople across all ethnicities.

This is why local efforts rooted in community partnerships are crucial, and the Board felt positive that more progress was now being made on this. Some members felt we underestimated how much we needed to do on this front, as people will have very individual reasons for questioning the vaccine, which requires staff resources to have supportive and sensitive conversations that can give the reassurance people need. The Board reflected on implementation challenges -many were centrally driven, e.g. logistics, planning, and supply have been "lumpy" and unpredictable, outside of local control. Nevertheless, the Board felt there were issues that we could have predicted, given the depth of knowledge of our communities across all ages, ethnicities, and needs, and experience of what has worked in the past.

Overall, there was a sense among Board members that we are "coming down the other side of the mountain", but there will be many more months for Covid response to come. We agreed to have a deep dive on the workforce at the next Board meeting, particularly in the context of growing pressure to step back up "normal" health and care services, while Covidpatients and the vaccine rollout remain major priorities, and recognising the trauma and burnout frontline staff are facing.