As a system one of our high level objectives is to create a longer-lasting legacy for our population – in particular looking to support the next generation to lead healthier and therefore more prosperous lives. That’s a high aspiration and particularly relevant as we prepare to celebrate 70 years of the NHS and think about the next 70 years!
So we have agreed to take a more focused approach to the first 1000 days and we’re working now to see how we can shape that to make sure it’s reflected in sensible plans across our partnership. This has evolved from the knowledge that the first few years of a child’s life will affect their health outcomes for the rest of their life; maternal mental health at the age of 14 is the best predictor of whether their child will enter school with what we call a health inequality (obesity is a good example) – and this gap is likely to never close.
Another key element in supporting someone’s health outcomes is to think about some of the wider factors that affect health. It’s important to realise that, in terms of someone’s health outcomes – i.e. the likelihood of developing poorer quality health, your life expectancy and so on – we in health, even if we did everything perfectly with no delays, would only ever affect around 20% of someone’s health profile. The remaining 80% is down to what we term the ‘wider determinants of health’, so housing, the environment, poverty, education. So to truly create a healthier population we need to tackle these other elements as well, and we can only do that by working in partnership. We are now starting to have those conversations and think about how we can work with our wider partners – in particular our local borough council colleagues, the voluntary and community sector – to shape this wider work, so watch this space!
In terms of our ongoing workstreams, we are taking a closer look to see if we have got these work programmes organised in the right way and we’ll bring you more news on that shortly. The majority won’t change, but we may look at renaming and refocusing some of our work to reflect our wider priorities. Importantly, and reflecting the national picture, we are also developing more local partnerships or alliances to focus on how we deliver care at a local level known as ‘Integrated Care Partnerships’.
Essentially these partnerships are alliances of local organisations – hospital trusts, mental health, community services, social care, public health, GP federations (GP practices which are now grouping together into wider partnerships of their own) and commissioners (the CCGs) – who are coming together to make the changes needed at local level. Across Surrey Heartlands we are developing three alliances which are co-terminus with the existing CCG footprints (so North West Surrey, Surrey Downs and Guildford & Waverley), with a clear remit in this first year to strengthen out of hospital services, improve access to the right urgent care services and thereby reduce inappropriate admissions to hospital. While at Surrey Heartlands level (now known as an Integrated Care System) – i.e. at a ‘system’ level – we will continue to focus on developing the right care models and best practice (supported by our Clinical Academy) and our integrated commissioning function which reflects our new devolution agreement across both health and social care.
It’s a complicated landscape, but one that is rooted in finding the right, and best solutions – working collaboratively with our partners, staff and local citizens – to support a healthier population, with easy access to the best services when people need them. For more detail on some of these technical terms and how these new partnerships are developing nationally, a good summary is given on the King’s Fund website here.