NHS Trusts are an important part of the system to address inequalities. As 'anchor institutions' trusts are key players in strengthening the health of the population in an area. Our recent report, Providers Deliver: New roles in prevention, demonstrates how trusts and their partners have worked together to improve health including through creating care plans with patients and representatives from across the health and care sector, and offering mental health support to those with heart conditions. Liverpool Heart and Chest Hospital NHS Foundation Trust described multidisciplinary teams as a 'golden thread', providing very local discussions about integrating mental and physical healthcare following cardiac surgery. The organisations working together understand that unless the care system works together, the long-term health of the population won't improve.
NHS England and NHS Improvement's 'Putting health into place' case studies provide further examples of how collaborative approaches that include both city planners and the NHS are a gateway to better care and to ensuring that broader challenges to population health are addressed. For example, County Durham and Darlington NHS Foundation Trust were part of a collaborative for a healthy new town that helped improve opportunities in education, training and skills as well as health and wellbeing.
Recently, trusts have been working to reduce inequalities as a result of COVID-19, initiatives include a South Warwickshire Foundation Trust and Public Health Warwickshire collaborating to support people experiencing homelessness during the pandemic, Barnsley Hospital's expanded discharge and support service that worked with local authorities to arrange food supplies for discharged patients, and Nottingham Healthcare Foundation Trust work with a data tool to identify populations vulnerable to COVID-19 risk. These are all cases in which trusts have worked collaboratively to identify ways in which the populations they serve can be better supported through the pandemic – playing their role and leveraging their influence locally as part of the jigsaw puzzle which is population health.
These are all cases in which trusts have worked collaboratively to identify ways in which the populations they serve can be better supported through the pandemic.
Following discussions with trusts, leaders recognise that the NHS has a responsibility to address wider inequalities and that as 'anchor institutions' they have a role in building a healthier, more equal society.
Accurately recording data is also key to understanding the issues faced by the local population, and NHS England and Improvement have asked all NHS trusts to review the quality and accuracy of their data, as a way to understand which populations are more vulnerable and adequately plan services. In some places, trust data and data on wider determinants of health and inequalities is being pooled or linked at the Integrated Care System (ICS) level to assess health inequalities alongside the wider determinants of health, and others are working at pace to put in place interventions for specific communities identified as being at risk.
As the health and care system, and local government, move towards closer relationships in the form of STPs and ICSs, it is important to reflect on how system partners can work together to provide a more holistic plan for population health. Aligning approaches to health inequalities across the public, private and voluntary sectors takes a collaborative effort and good relationships between actors.
The provider sector has a role to play in partnership with many others including, primary and social care, including through teachable moments.
The provider sector has a role to play in partnership with many others including, primary and social care, including through teachable moments. For example, a 2018 UCLH Cancer Collaborative pilot promoted awareness of the continued need to be vigilant for cancer despite the "all clear" result. The Making Every Contact Count is a good way for trusts to embed prevention into the core business of the NHS.
The disbanding of PHE has led to suggestions that some public health activity is likely to move back into the NHS, such as sexual health, screening, and immunisation. Trusts take their role in prevention and public health seriously, but wherever these services sit, and under which agency, these functions need to be sufficiently funded and resourced.