In the context of the NHS long term plan and the renewed emphasis on system-wide prevention, trusts are increasingly focusing on a system-wide approach to population health and prevention as a key partner in the endeavour to join up work to improve the health of the populations they serve. The long term plan makes clear that as part of the nationwide move to integrated care systems (ICSs), NHS trusts will need to play their part in supporting a healthy population.
In partnership with the Provider Public Health Network, which brings together public health professionals working in or with the provider sector, NHS Providers has developed a framework intending to guide NHS trusts to consider their approach to population health systematically, and help them prioritise and develop their work in this field.
Collaborative working
Local health and care systems are made up of numerous organisations, all providing different services but all, in the era of integrated care, working together as members of local sustainability and transformation partnerships (STPs) or ICSs.
Typically someone’s experience of the healthcare system will involve contact with more than one organization: their GP practice, an acute trust, perhaps their local ambulance service or a community healthcare team, as well as social care and other local authority services.
Typically someone’s experience of the healthcare system will involve contact with more than one organization: their GP practice, an acute trust, perhaps their local ambulance service or a community healthcare team, as well as social care and other local authority services.
Trusts can join forces to improve peoples’ health by collaborating with commissioners, other health and social care providers, and the voluntary, community and social enterprise sectors to make a plan for improving health. In Leeds, hospital specialists, general practice, and public health are working together to diagnose liver disease earlier, by identifying areas in the city with high areas of obesity and alcohol consumption. GPs have easier access to diagnostic tests, and hospital specialists run clinics in GP practices for those with abnormal results. This has helped to identify people with liver disease who may not otherwise have received treatment.
Prevention as core business
With 23.4 million attendances at A&E and 89.4 million outpatient appointments per year, the provider sector features heavily in peoples’ contact with the NHS. Within each of these contacts lies an opportunity for health care providers to support preventative work, in recognition that a holistic approach to a person’s health is often the best way to treat their condition.
For example when vulnerable people visit A&E, or expectant mothers attend their pre-natal appointments, it is often an ideal time to offer them opportunities and information to improve their health. Providers can grasp these opportunities with both hands, forming part of the wider system’s endeavour to improve population health. Making a success of this takes board level attention, in-house expertise, and explicit strategic recognition of the importance of prevention and health improvement in the work trusts do day to day.
Healthcare professionals need to be supported to assess needs for prevention and health improvement, and equipped with the tools they need to provide information, advice and onward referral when necessary.
Healthcare professionals need to be supported to assess needs for prevention and health improvement, and equipped with the tools they need to provide information, advice and onward referral when necessary. Initiatives like Making Every Contact Count (MECC) can support this. Staff at Lancashire health NHS foundation trust have been provided with e-learning covering MECC across the four main health-related behaviours, and MECC conversations have been embedded into the trust’s culture and way of working, with 17,000 taking place each month across the trust.
Meeting the needs of the population
To design services which effectively meet the needs of the population they are designed for, trusts must first understand those needs. Data collected by the trust and by other system partners offers a window of insight into the current health needs of the local population.
Trusts seeking to design high value services should systematically collect and analyse data on needs, activity and outcomes, and put their analysis to work while implementing services, as well as sharing this data where appropriate to contribute to local population health needs assessments. For example, Nottinghamshire healthcare NHS trust is using its data to identify people with severe mental illness who are less likely to take up bowel screening offers, and working with these patients to improve their access to screening.
Health protection and the wider determinants of health
The provider sector’s existing role in emergency planning, infection control, and the delivery of immunisation and screening programmes already make an important contribution to protecting the health of the population it serves.
ICS plans will be required this year to outline how local organisations will work to reduce health inequalities in their areas.
ICS plans will be required this year to outline how local organisations will work to reduce health inequalities in their areas. It’s clear that trusts have the opportunity and means to support this agenda in a number of ways, whether that is through acting as ‘anchor institutions’, playing a vital role in their communities in providing inclusive employment opportunities, or supporting local businesses through their procurement practices.
The 2012 health and social care act and the transfer of public health duties to local authorities may have resulted in a reduction of the involvement of NHS organisations in population health activity. However with increasing health inequalities and funding pressures on both sides of the fence, there is a well recognised case for more integrated approaches to planning and delivering care with population health and prevention in mind.