For the first time in a century, the macro indicators of overall health in the UK are not getting better. Life expectancy has stagnated, and, in the poorest areas, infant mortality rates are getting worse. Although the government has invested an extra £20.5bn in the NHS over the next 5 years, success in reversing this trend is not guaranteed.
Healthcare provision typically makes up less than 50% of the overall health outcome of a population. The factors that affect population health are wide-ranging and complex and go far beyond the traditional reach of the NHS.
Health systems under pressure
Turning this around requires a whole system approach, with increased collaboration between the organisations who contribute to population health. It also needs to focus on prevention to shift the balance. This was reiterated in the government’s long-term plan. As well as an emphasis on personalised care from multiple organisations around the patient.
Whilst these ideas are not new, leaders struggle to make the impact that they desire to have for their communities, regions, and populations.
The NHS remains under as much pressure as ever after a decade of efficiencies and the need to demonstrate long-term returns from the £20.5bn investment over the next five years. Councils are on the road to bankruptcy and major changes to the benefits systems make the future of our population health uncertain.
What can the health leaders do?
The factors affecting population health span across the breadth of the healthcare, local government and welfare systems. So, what can leaders do to reverse the trend and turn the tide towards better population health in the UK?
1. CREATE STRUCTURE
Organisational structure is within the control of national, regional and local leaders.
Today’s NHS is not what you would develop if you had a blank sheet of paper. It is mind-boggling, even before you include the other bodies who contribute to health and social care including councils.
With over 200 Clinical Commissioning Groups (CCGs) and over 200 providers, there is too much fragmentation. To compound this, there is also financial imbalance with years of increased spending on, and increased demand for, acute services (where most of the deficits are) and not enough focus on preventative and primary care. Structural re-balance is required to provide a system-wide solution for population health.
Councils and CCGs are already on the path to integration through vehicles such as the ‘Scientist Training Programme’ and Health and Wellbeing Boards, as well as the Manchester Devolution Agreement, but has this gone far enough? Legislative change is required to really force further collaboration, but this is unlikely in the foreseeable future. In the meantime, leaders should focus on putting the enabling strategies – such as Workforce, Capital and Estates, Digital and IT – in place between collaborating organisations to make it easier to work together to improve population health.
2. LEAD ACROSS THE SYSTEM
Integrating care requires different leadership. Leading a single organisation is not the same as leading across a system. System leadership needs a different governance model and a different leadership mindset.
There is not a central design of best practice that organisations can look to. Instead, it is iterative and emergent and informed by the outcomes that you are looking to achieve across the system. Leaders will need to be increasingly comfortable operating in ambiguity and being willing to release control.
The current absence of statutory support makes decision making cumbersome and encourages local duplication. To combat this, leaders need to take time to be deliberate about collaboration. Leaders across systems must own each other’s problems. They need to develop shared visions and they must not only target quick-wins but must tackle the difficult issues together.
3. EMBRACE DIGITAL OPPORTUNITIES
The Secretary of State for Health and Social Care, Matt Hancock, believes that digital is the next evolution in healthcare. 90% of the world’s data has been created in the last 2 years, and the cost of linking data sets is a tiny fraction of what it was a decade ago. This creates more opportunities for health system leaders to make better decisions to improve population health than ever before.
Data analytics and AI can improve decision making and enable smarter allocation of scarce resources. AI can help mine unstructured data to improve insights that would be impossible in traditional paper-based systems. Gathering these insights helps improve the ability to predict the factors affecting the onset of poor population health and make timelier and less costly interventions.
The challenge for leaders in realising this potential is not the technology or the data itself, but the organisational change required across the system to start deriving the benefits from it. The NHS needs to be at the forefront of harnessing technology and data to improve not only the patient journey but overall population health.
In the UK in 2019, we have universal healthcare services, but we do not have universal access to the factors that affect health outcomes. Often the neediest don’t get the access they need, further disenfranchising the worse off and widening health inequalities.
Keeping people well is more important than keeping people out of hospitals. Prevention needs to be a core part of the NHS business, and this needs to be part of a multi-system response which also includes housing, welfare, and other council services.
Achieving this will require leaders at national, regional and community level to make difficult choices about today’s challenges. Not only does this approach require services to invest when the benefits will be seen elsewhere. But when it comes to population health, the benefits of this approach may not be received for a considerable period of time.