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An opportunity to join two agendas

Ahead of the King’s Fund annual conference in November, Dr Durka Dougall, the organisation’s senior consultant, says the health and care sector now has the chance to join up population health and prevention in order to improve services for those who need them.

Relentless headlines paint a formidable yet familiar picture.

•  The increasing demands of a growing and ageing population with complex needs have put pressure on health and care finances at a time of unprecedented funding restraint. NHS providers of hospitals, ambulance, community and mental health services are planning for a £500m deficit in 2017-18. Thousands of disabled and older people are dependent on care budgets which have been cut by £5.5bn over the past six years;
• Improvements in life expectancy seem to have stalled. Unwarranted variations remain, and inequalities in health are persistent and hard to shift;
• A dedicated workforce is struggling to cope with the pressures, with concerns about the future and what may lay ahead;
• A stark assessment of the sustainability and transformation plans in London that relate to reducing the use of hospitals ‒ ambitions to prioritise prevention need to be backed up by more detailed proposals;
• And yet, more than 100,000 deaths each year in people under 75 are preventable. In total, 40% of ill health in England can be explained by risk factors that can be changed.

This suggests that action needs to be taken to improve health and care – and indeed much is already being done. However, I would argue opportunities still exist to further join up thinking on population health and on prevention.

People reading this article are likely to fall into one of two camps. First, there will be those who are involved in system reform. Those people may be working in a clinical commissioning group or hospital trust, or are part of a sustainability and transformation partnership or a fledging accountable care system; they are likely to be working at pace to deliver improvements at scale, and their focus predominantly on the NHS and its structures. 

Other readers will work in local government, traditional public health teams or one of the many community-based organisations working to improve education, transport, housing, and wider determinants of health. Their approach is likely to be slower and more characterised by understanding, involvement, community mobilisation and a democratic mandate. Their focus is on maximising wellbeing, independence and upstream measures to prevent ill health.

To some, the former group represents ‘population health’ and the latter more ‘prevention.’ While the use of these terms can be disputed, it is widely accepted that the agendas of these groups rarely align fully. In system integration efforts, for example, there is often poor representation of the community – local residents, voluntary care sector, elected members. Also, the converse can be true. Local community efforts can be narrowly focused rather than system-wide or joined-up.

But in combination, these agendas are capable of bringing about impressive improvements to health and care.

Dorset organisations, for example, have brought about large-scale improvements through their cross-system partnership working. Like north west England regions, they describe the importance of system leadership efforts from council and community leaders. In Sheffield and Bracknell Forest, public health professionals supported by local system leaders reach far across their economy to improve health and care. Organisations working across boundaries demonstrate impressive achievements (e.g. Soil Association’s Food for Life Programme, Bromley-By-Bow Centre, GSK Impact Award winners).

So, what is needed to be able to harness this opportunity?

System leaders must embrace prevention as a key part of their work. A system that is able to meet the changing needs of the population must focus on prevention as well as current demands. This has been recognised in the NHS Five Year Forward View. There are many resources available to help you.

•  To make a difference in your area, you need to understand the people you are trying to serve. There are many individuals, community organisations and elected members who can reach out to different groups and have invaluable insights about local priorities. Look at your integration partnerships and question – who and what is driving the agenda? Is it local people and those who understand them? If not, how can you get them actively involved?
• Local public health teams have expert skills in prevention, health intelligence and engagement. They can offer guidance about what works for prevention and what is needed in your local area. Speak to them and ask what they can offer;
• Many regional and national organisations can offer support. Our own accountable care systems and organisations learning network, the Royal Society of Public Health and Public Health England’s guide on everyday interactions or the mayor of London’s Health Inequalities Strategy are just a few.

Those working in prevention must see the importance of a joined-up approach with buy-in from the most senior leaders across partner organisations. The integration agenda offers a crucial opportunity for you to deliver the improvements you seek. Don’t wait to be asked; you’re needed – find a way to join in. Key to this is to:

•  Understand the need for collaboration. Our work on unhealthy behaviours demonstrates a ‘clustering effect’; a person who is unemployed in the community is likely to also have poor housing or lack of access to healthy and good-value foods, and so a whole-system approach is needed;
• Understand the important contribution you can make to the health and care of your community;
• Develop the leadership skills to support collaboration across systems, to influence effectively and to bring about the change that you aspire to make.

At the King’s Fund, we are developing materials and programmes to support colleagues working in the areas of population health, public health and systems improvement to take advantage of the opportunities offered by joining up population health and prevention.

Day one of our annual conference (29-30 November) will focus on the practicalities of improving population health and prioritising prevention by looking at how to strengthen partnerships between all those working in local areas.

We are also working on a project to develop a vision for the public health system in England. You can find out more about or get involved in this work at kingsfund.org.uk/projects.