1 Identify target population groups
NHS trusts will be aware of the risk factors that are now linked to a more severe course of illness and prognosis for those infected with SARS-CoV-2, as detailed in the NHS England risk stratification tool development.
For provider organisations, identifying segments of the local population with these heightened risk factors for COVID-19 could provide a useful starting point in marshalling where services can have the greatest health impact on the needs of the local population.
This toolkit aims to highlight some routes previously taken by NHS trusts (some prior to the COVID-19 pandemic) that could help maximise the positive impact of NHS providers’ services on the local population, and act as a building block for broader efforts to address health inequalities across the local population. Resources that may be useful for NHS trusts and partners include the updated PHE health equity assessment tool (HEAT) and HEAT e-learning for assessing and driving action on inequalities and equity. Some services have now embedded this process into their business planning or annual service reviews. Examples from practice below, detail where NHS trusts and local health system partners have used routine data to identify local population needs. Additional PHE resources that may be of use include SHAPE to support service configuration, and the local health tools, which can help when considering indicators for small area geographies.
Figure 4
Population factors for COVID-19 risk and adverse outcomes
Some factors may be more relevant to particular types of trusts, while less relevant to others.
2 Review and adapt approaches
With many innovative approaches introduced at pace during the COVID-19 response – for example integrated workforce and volunteer models - there is opportunity for NHS trusts to consider building on these to strengthen links with community assets and enabling effective prevention, care and rehabilitation pathways. With 92% of trusts reporting concerns about stress and burnout among their staff, reviewing workforce health and wellbeing needs as part of this process will also be crucial.
The Health Foundation has highlighted how NHS trusts in their ‘anchor role’ can “support and accelerate local recovery from COVID-19”, while helping to mitigate some of the significant social and economic impact of the COVID-19 crisis on local populations. NHS trusts are acknowledged as: "large, public sector organisation with a significant stake in local communities and potential to influence their health and wellbeing – [this] could help to mitigate some of the negative social and economic impacts of the pandemic".
3 Action plan
Figure 6
4 Integrated care / system collaboration
Undertaking a review to identify and map local population inequalities gaps against a selection of targeted services delivered within NHS organisations will help identify where efforts will have the greatest impact, as well as highlighting potential areas of unmet local population need. This process can also help generate insights on how work already underway within trusts could help to mitigate against a widening of inequalities (and variation in health outcomes) during local health system COVID-19 recovery phase.
Reviewing population inequality gaps across a system can help identify priority actions for service providers, while also strengthening coordination and consistency of approach across partners during the local COVID-19 recovery phase. STPs/ICSs could be a helpful convenor for these conversations, recognising that different system partners will have a variety of intelligence that they can contribute, for example local authorities being well placed to help identify at risk populations. This concerted effort can help to identify populations at increased risk of SARS-CoV-2 transmission and/or more severe consequences of infection, such as people with complex needs and potentially currently underserved populations, for example traveller communities, BAME populations, or those who are homeless.
A cross system review could help to identify what is working well, sources of local assets, and to also help avoid pockets of duplication.
Reviewing data sharing and information governance agreements in place across providers – including GP services – can also enable improved integrated care.
The use of a matrix approach has been adopted across Cambridge, Lancashire and South Cumbria, and the Midlands, to review evidence, identify population needs and to assist prioritisation (see appendix).
5 Leadership actions
As mentioned, ICSs can provide useful cross-partnership leadership support for the coordination of locality services and identifying system-wide needs. Alongside this, leadership at trust-level – including crucially from within NHS trust boards – is pivotal in identifying and addressing local health inequalities, particularly as ICSs can be quite large, and where geographies are diverse, a place-based approach may allow for a more locally tailored response.
The contribution that provider organisations can bring to tackling health inequalities - both those impacted by COVID-19 and those affected by underlying existing inequity – is recognised by NHS England’s reference to having ”a named executive board-level lead for tackling inequalities” as part of phase 3 COVID-19 response.
Provider-level leadership for addressing health inequalities both during COVID-19 restoration and recovery, and beyond will help to inform coal face action in the first instance. This local intelligence can then be reviewed at ICS level for wider evaluation of how this works out and impacts across the ICS population, on service variations and population health outcomes. This requires a consistent process to enable both local and ICS level accountability for reporting, reviewing and taking action for the ICS population, based on local intelligence.
Individual health and care providers can do much internally to measure, take action, and advise on prioritisation of actions during recovery phases. Recognising that most interventions will take place locally at a neighbourhood level, data analysis and leadership/coordination might take place more at place- and system-level. Local leadership in the first instance is key and may also involve collaboration from NHS trusts with primary care and social care.