'Avoidable and predictable': Lancashire's higher-than-average Covid death rate
A report concluding that Covid hit places like Lancashire harder than many other parts of the country makes for depressing reading - but should come as no surprise.
That was the reaction of council leaders and Lancashire’s public health boss to a study which found that the county had a nine percent higher Covid-related death rate than the England average in the 12 months after the virus struck.
The Northern Health Science Alliance (NHSA) report also estimated that just over half of the increased level of Covid fatalities across the whole of the North of England could be attributed to either pre-existing poor health or deprivation - meaning that they were “potentially preventable”.
That would equate to 15 possibly avoidable Covid deaths per 100,000 people across the 77 northern local authority areas that were examined for the “A Year of Covid in the North” document.
The report makes a series of recommendations about how the health divide between the north and south of England could be bridged to better prepare more deprived parts of the country for future health shocks - and to improve health more generally.
While Preston City Council leader Matthew Brown welcomes any ideas about how to prevent history repeating itself, he says northern leaders like him were only too aware of the uneven impact of Covid within weeks of it striking - so although he acknowledges that the findings of the report are shocking, they have not left him particularly shocked.
“It became obvious very quickly...that less well-off communities were being disproportionately affected. It's heartbreaking as a council leader when you’re told that five people have passed away on one street in a ward which is less well-off.
“I was devastated - and I wanted to do something, but obviously it is those entrenched inequalities that really have led to the findings in [this] report.
“Those in the gig economy or providing services during the pandemic have been disproportionately hit - especially the BAME community, because they tend to be more on the frontline, as are other low-paid workers.
“Initially, it was hard to get an answer from anyone as to what we could actually do - and that’s not a criticism of anybody, because people were reacting to an unexpected dynamic,” Cllr Brown adds.
Preston was one of the first parts of England to go back into local restrictions after the lifting of the first lockdown last summer - with city-wide rules imposed from 7th August. That was just a week after the same fate had befallen parts of East Lancashire, with local lockdowns also gradually enveloping the rest of the county as autumn approached.
The persistently higher infection rates that promoted those restrictions all pointed towards the fact that Covid was far from under control in Lancashire.
For Cllr Brown, that was reflection both of the immediate government response - and more deep-seated issues dating back decades.
“There was a sense of powerlessness at first in terms of councils not having the resources and the powers to tackle the pandemic in the way that we wanted - in particular, [by] having public health professionals running contact tracing and testing.
“The self-isolation payments also came a few months after they should have done - and there were no regulations, properly, to close down businesses in a speedy manner.
“But then you also have to look at things like housing - there are lots of families living together in overcrowded accommodation and that has really come to the fore [during the pandemic].
“And if people have lower incomes, obviously their health is more at risk in terms of the food that they eat - and the conditions they [live in] are less satisfactory than one would hope. So if a pandemic comes along they are going to be more at risk,” Cllr Brown muses.
Although Lancashire's Covid mortality rate across the first year of the pandemic was higher than the England average, it did not exceed it by as much as some other parts of the North West, such as Greater Manchester - where it was 35 percent higher - and Merseyside, which registered a 28 percent higher Covid-related death rate than the national average. However, Lancashire did perform more poorly than Cumbria, whose rate was one percent lower than that across England.
The NHSA report also assesses the economic impact of Covid on northern communities, where weekly gross pay fell slightly in the year to March 2022, in comparison to a fractional rise in England as a whole. Wages by that measure were already far lower in the North before the pandemic - £543 compared to £600.
South Ribble Borough Council leader Paul Foster says statistics like that vindicate Lancashire's attempt to secure a bespoke finance package with the government - much of it to support struggling businesses - ahead of the county being placed in what were then the most severe tier 3 restrictions last October.
“Many people were trying to claim we were playing party politics, but we weren’t - we were genuinely trying to get a very valid point across that wasn't being addressed.
“It’s not a level playing field - and to try to treat every part of the country the same was just the wrong thing to do.
“The lockdowns were destroying our local businesses - and I think there are many of them that will never recover.
“From day one, we knew the North of England was going to be impacted disproportionately more than any other area of the country - we know that the most vulnerable and poor in society are always impacted the most when it comes to any type of emergency,” Cllr Foster says.
After a week of tortuous negotiations with the government, Lancashire eventually secured a £42m package of funding in return for accepting tier 3 status - £30m more than the standard amount it could have expected because of the size of its population. However, the settlement was still far less than the £58m the county had been seeking.
Cllr Foster says that while restrictions have been lifted, their impact will leave a long legacy - and he fears that the pandemic is far from over.
“Infection rates are out of control - you only need to look at the data for Scotland to see that they are going to hugely increase over the next two to six weeks [following the return of schools].
“Deaths went over 200 a day [nationally] for the first time since March - and it galls me that we don't even seem to want to [discuss] that now.
“I hope I’m proved to be wrong, but I think matters might get worse before they get better - we have got to get through this winter and see what it brings us.”
"SAD BUT NOT SURPRISING"
The disproportionate effect of the pandemic on Lancashire and other parts of the North West was "avoidable, unnecessary and unjust”, according to the county’s public health chief.
Dr. Sakthi Karunanithi, director of public health for Lancashire County Council, had been spearheading work on how to tackle health inequalities before the pandemic struck.
He says that their real-world impact - already felt by those who were experiencing them - has been brought into sharp focus for society as a whole by the experience of the last 18 months.
“It’s sad but not surprising - and a reminder that the places where we live, work and go out with our families and friends do matter in determining our health and wellbeing. That's why investing in our NHS alone will not really address this - and we need to invest in our places and communities [in order for them] to thrive.
“Health inequalities have been compounded by the pandemic - and we need a fully-resourced long-term plan to turn it around that can live beyond electrical cycles.
“We need to start thinking about prevention - we need to invest in the causes of the causes [of health disparities] and support people in having better life chances. That means
investing in child development and reducing the number of children living in households in absolute poverty.
“We also need to embed health and wellbeing in all policies that we develop - whether that is on the environment, the economy, housing, transport or education. We need to invest in communities with higher health needs - [be that] deprived or ethnic minority communities, or wherever vulnerable communities exist,” Dr. Karunanithi said.
The Northern Health Science Alliance (NHSA) report exploring the harsher impact of Covid on the North of England recommends a raft of short and long-term responses to its findings.
As an immediate action, the authors suggest targeted vaccination programmes focused on those areas and populations where take-up is low. However, the study did find that the North West had the second-highest Covid vaccine rate in the country over the first six months of the rollout.
The document also proposes the creation of ‘Health for Life’ centres across the North, offering life-long programmes of health and wellbeing advice and providing support services from pre-natal schemes to healthy ageing programmes. It recommends targeting the facilities in the most deprived areas as a way of preventing ill-health from becoming entrenched in less well-off communities.
Locally-focused pandemic preparedness plans should also be developed to safeguard vulnerable groups, such as those in care homes, people with disabilities and those suffering chronic ill health in the event of a similar crisis occurring in the future, the report says.
A £1bn ring-fenced fund to tackle health inequalities at a regional level - as well as increased funding for local public health teams - is also proposed.
The call came just 24 hours after the government announced £36bn in new funding over three years to be split between the NHS, social care and the ongoing response to Covid.
Health Inequalities lead for the NHSA, Hannah Davies, said of the partnership’s report : “As we approach autumn with uncertainty around an expected increase in COVID-19 cases and with increasing questions about what ‘Levelling Up’ will mean for the North of England it is clear significant action must be taken in tackling health inequalities.
“The Government has made clear its commitment to level up and to tackle health inequalities, this report shows the importance of making that a reality with significant funding to tackle ill health through significant investment into public health and the NHS in the North of England.”
COVID IN NUMBERS
17 - number of Covid-related deaths per 100,000 people in Lancashire
9 percent - higher Covid mortality rate in Lancashire than the England average
51 percent - of increased Covid mortality across the North of England was due to deprivation or poor health
15 - number of Covid-related deaths per 100,000 people in the North of England that were potentially preventable
Source: "A Year of Covid in the North" report by the Northern Health Science Alliance (all figures cover March 2020 to March 2021)