Comment

Beyond integrated care and towards population health systems

David Buck, senior fellow, public health and inequalities at The King’s Fund, reflects on the need for inclusive transformation to deliver population health systems.

While integrating care services is part of the journey to a transformed health system, it is not the destination. In light of this, we published a report last year pushing for a stronger policy and practice focus on population health systems. The report aimed to challenge those involved in integrated care and public health to ‘join up the dots’ – to see integrated care as part of a broader shift towards an approach focused on improving population health.  

If further proof were needed, the global burden of disease study on the United Kingdom showed that while life expectancy in England on average has been growing faster than many other developed countries, there remains significant inequality in life expectancy, while in terms of morbidity there has been little or no improvement since 1990 in how long people live with illness and disease.  

So people are living longer but in poorer health – which neatly encapsulates the challenge for integrated care. Many people of working age, particularly from lower socio-economic groups, now have multiple comorbidities. Although more of us than ever are likely to reach old age, integrated responses to health need to respond as, and before, we get there. Integrated responses will also need to bring in different balances of medical, care and social models of health to match people’s circumstances. 

Approach to integrated care must develop 

Our approach to integrated care needs to develop if we are to keep up with the changing needs of citizens and patients, and those who will be patients in the future. In short, the health and social care system needs to be better integrated with other public services and the communities they serve across the life course, not simply in old age. 

Making this a reality systematically and at scale is not straightforward and will not be quick. But it is happening. The shift of public health to local government, despite the cuts in funding, has been helpful. The move towards devolution in Greater Manchester but also elsewhere is consistent with this. In London, Haringey’s devolution pilot, which is all about prevention, is a great example of this and the LGA and Association of Directors of Public Health publication on public health’s role in integration showcases other examples.  

Transformation needs to be fully inclusive 

From the local government ‘side of the house’ there has, therefore, been progress. The messages about a strong commitment to a radical upgrade in prevention are also a very clear signal from NHS England that the NHS needs to play its role much more strongly than it has done in the past.  

The move to place-based planning through sustainability and transformation plans (STPs) is a golden opportunity to make this a reality. There are of course challenges in this, for a true move towards population health systems requires a focus on the ‘T’ of transformation as well as the ‘S’ of sustainability –  and for that T not to be just about the rearrangement of NHS services, however pressing that may be. The T needs to be fully inclusive and integrated with local government’s role, the contribution of the voluntary and community sector, business and communities themselves.  

This is a big ask, but the time and opportunity is right for it. One big test will be the outcome of the STP process in October, which we hope will show the journey towards population health systems moving on apace.  

This journey is one that The King’s Fund fully supports and is committed to helping make a reality. It was one of the themes of our Integrated Care Summit last year, and is at the core of this year’s conference. 

We will hear how accountable care systems, from here and abroad, are developing their role to focus on population health;  examples of integrated approaches to physical and mental health; housing and health; social prescribing; and how to bring together local partners to contribute to developing population health systems. 

Population health systems are for the health of everyone and we hope that everyone will find something of interest at our Integrated Care Summit this year.

FOR MORE INFORMATION

The Integrated Care Summit takes place on 11 October 2016 at The King’s Fund, London. Details about the event can be accessed at:

W: www.kingsfund.org.uk/events/annual-integrated-care-summit-2016

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