This striking comment from Dr Bola Owolabi, Director for Health Inequalities Improvement at NHS England, represents an increasing emphasis that health improvement for populations can and should largely be achieved through tackling health inequalities and a focus on the most disadvantaged groups.
This message brings tackling health inequalities to the heart of overall population health improvement, instead of an add-on or afterthought.
Since my last blog on health improvement and inequalities in late May there have been a lot of important developments in this space. These all play out in the context of the journey to fully establish ICSs, and the continued (and deepening) challenges around elective care recovery. Challenges that are only magnified by the intensity of demand on primary and urgent care services.
I outline a brief personal review of some of these developments and key issues for ICS and place-based partnerships as we head into the autumn months.
Emphasis on genuinely collaborative partnership working with communities and across organisations is building all the time. Over the summer we saw this evident in 'Reform for people - A joint vision for integrating care' put out by National Voices, the King's Fund, and multiple charity partners. More recently, we have further ICS guidance from NHSE, including Working with People and Communities; Partnerships with the VCSE; and the role of IC Partnerships within ICSs. These all reflect a level of collaboration, engagement and co-production with people and communities that goes way beyond the traditional 'comfort zone' of the NHS. But it is vital if ICSs are to get real traction in reducing health inequalities.
Addressing wider factors and helping people to stay well needs to be given as much emphasis in partnership work as improving the provision of health and care services for people with existing needs. [Reform for People..]
Insights from the summer NHS Confed conference
The nature of collaboration, leadership and culture-shift was also a key topic of interest at the NHS Confederation Virtual conference in early summer. SCW hosted a session with Fiona Edwards (ICS Lead - Frimley Health and Care), Dr Rupa Joshi (GP and PCN Co-Clinical Director in Wokingham) and James Williams (Director of Public Health - Medway Council). This stimulating panel discussion on ICS's and the drive to improve health and reduce health inequalities touched on several important themes for ICSs:
- Taking a fully engaged, collaborative focus on reducing health inequalities - integration isn't just about more joined-up healthcare services.
- 'How can we help you to help your community' - recognising the enabling role to support community initiatives on health improvement.
- Applying the experience and lessons of the pandemic response and vaccination programme:
'I have learnt more about other system & community partners in the last year than in the previous 20' enthused Rupa Joshi.
- Developing a shared purpose with system partners, avoiding NHS dominance.
'Build a curious, humble mindset' was key advice from Fiona Edwards about system partners
The Confed recording of this session is still available and well worth hearing the insights of three inspiring leaders.
On the national scene, two key governmental developments stand out - the re-naming of the original Office for Health Promotion to become the Office for Health Improvement and Disparities (OHID), and another re-naming and a new minister for the Department for Levelling Up, Housing and Communities, under Michael Gove, previously the Dept. for Communities, Housing and Local Government. The renaming of the OHP to OHID is a positive move, and hopefully reflects a genuine recognition by government that health improvement isn't just about changing individual behaviours but impacting on underlying causes of health inequality.
Sajid Javid, Secretary of State for Health and Social Care, spoke on this at a recent speech, outlining the role of OHID, under the leadership of Dr Jeanelle de Gruchy from the Association of Directors of Public Health (ADPH), including a focus on disparities and upstream social factors. But as Dr Jennifer Dixon of the Health Foundation noted,
'We now need action to follow these warm and welcome words'.
That action should include a cross-government health inequalities strategy with clear measurable goals, as called for by the Health Inequalities Alliance. This would include close coordination and alignment of strategy and action between DHSC and the Dept. for Levelling Up. The underlying paucity of public health budgets, however, remains a key limiting factor, as Sir Michael Marmot highlights.
National support and strategy
Turning back to the development of Integrated Care Boards and partnerships at system and place level, the national Health Inequalities Improvement Team is gaining real presence and impact on how ICSs are approaching the challenges of health disparities. The refreshing and positive approach promoted by Dr Owolabi and the team, based on Quality Improvement theory and particularly Appreciative Inquiry, places an assets/strengths based model at the centre. This is supported by using data for insight and working through strong engagement and co-production with communities and the VCSE.
In support of this approach, a half-day learning event takes place on Tuesday 28th Sept ‘Health Creation in the delivery of the NHSEI health inequalities priorities’, run by the Health Creation Alliance and sponsored by NHSE, and is strongly recommended.
The national Health Inequality Improvement team is also engaging widely on a framework to help focus action on key health inequality issues and to link this to priorities in the Long Term Plan.
The ‘Core 20 Plus 5’ initiative (still under development but likely to be formally launched later this year) is designed to drive targeted health inequalities improvements in the following areas:
• Core 20 – Targeting the most deprived 20% of our population (lowest Index of Multiple Deprivation (IMD) quintile areas).
• PLUS – adding other population groups as identified by local population health data, e.g. ethnic minority communities
• 5 – and targeting five key clinical areas of health inequalities: Cardio Vascular Disease (CVD), Cancer (early diagnosis), Respiratory, Maternity, and Mental Health (including Children and Young People (CYP)).
The quality improvement approach promoted by the national team, combined with the Core 20 Plus 5 initiative, and the level of engagement and communication/networking underway all give a strong sense of momentum for collective impact on reducing health inequalities. To find out more join the FutureNHS group.
In my next blog, I’ll focus on some of the work SCW is doing in this space, with examples of ICS and Place level programmes that are contributing to this major health and care priority.