Public health good practice in ICSs and ICBs

• Securing funding for inequality work, before NHS inequality funding was determined
• Developing an inequality strategy for the ICS
• Developing a prevention strategy
• Establishing working groups to put inequality at the heart of the system
• DPHs taking a leadership role in prevention and population intelligence agenda
• Delegating inequality funding to place level (oversight of DPH, with place-based directors and voluntary sector lead)
• Using evidence-based bid system to drive down inequality at place and sub-place level

• Persistence to create the space needed
• Courage to change what doesn’t work
• Trust and good relationship building
• Keeping dialogue open
• Commitment to joint working
• Evidence-based agendas and funding decisions

• Using a Population Health Management approach to identify and stratify high-risk cohorts
• Working with the community and voluntary sector to develop innovative solutions
• Using the #KnowYourNumbers campaign to raise awareness
• Using a system wide dataset to map people who have blood pressure recorded in primary care and whether people with high BP readings have a diagnosis and treatment
• Developing a community-based ‘test and learn’ approach to complement the NHS Health Checks and recording of BP through primary care
• Engaging with identified ‘at risk’ cohorts in ongoing blood pressure testing and management, including behavioural risk factors
• Looking back at cases of acute CVD events to understand their blood pressure records and opportunities to intervene earlier

• Building on what already exists
• Space and time to innovate
• Valuing the learning
• Working with a wide range of partners
• The contribution of the voluntary and community sector
• A real desire to take action with the systems thinking ethos ‘start somewhere and follow it everywhere’

• 13 local authorities
• OHID
• NHS Trusts
• Care System Support Organisations
• UKHSA
• NIHR Applied Research Collaboration (ARC)

• Support from the King’s Fund, who has identified the North East North Cumbria ICS as an area of leading practice in the country in their forthcoming publication with the Health Foundation
• Developed an infrastructure – Healthier and Fairer ICS Advisory Group – to drive forward work on healthcare inequalities and prevention, using a leadership model of a lead Director of Public Health, Medical Director, Clinical Lead and OHID lead
• Developed a range of tools, seminars, products, position statements and training, including the development of a Health Equity Academy and a Public Health Intelligence Scheme across local authorities and the NHS
• Secured £13.6m funding per year for five years, which included:
  • Match funding Fresh, the regional Tobacco Control Office
  • Funding an Alcohol Care Team in all eight Acute Trusts, above and beyond the national NHS England funding
  • Scaled the Tier 3 Obesity services and driving forward work on a whole systems approach to healthy weight
  • Worked with the community and voluntary sector to adapt their work on poverty, proofing to clinical pathways and scaled the community champions programme, building on the work from the pandemic
  • Secured £9m across 13 local authorities to match fund the national drugs funding, ensuring the general healthcare needs of those with drug and alcohol issues were addressed (this work was identified as a model of good practice by Dame Carole Black) 
  • Provided funding to their Deep End Network of GP practices
  • Scaled the Health Literacy programme, in response to the low reading age being a major barrier in preventing access to healthcare
  • Ensured evaluation and research was built in to demonstrate impact, working with ARC colleagues

• Building on the significant partnership approach in place across the North East
• Ensuring public health consultants were appointed in each of the NHS Trusts across the region
• ARC being the lead for health inequalities and prevention nationally
• Support from the King’s Fund to learn from expertise, inform the ICB’s approach, and agree principles to work better together as a public health family

• Public Health team
• Voluntary and community groups
• Schools and colleges
• GP practices
• Local businesses
• Town and Parish Councils

• Developed Community Health and Wellbeing Hubs in partnership with local authorities, primary care networks and the community and voluntary sector to support people with health and wellbeing services
• Provided data for the development of multidisciplinary teams working in Bishop’s Castle
• Developed easy to read profiles outlining the specific and health and wellbeing needs and opportunities within an area
• Supported the investment and development of community and family hubs in North Shrewsbury, including family stay and play, baby weighing, and investment in youth activities

• Strong partnerships
• Intelligence and data
• Wide engagement

• NHS South Yorkshire ICB Prevention Team
• Five local authorities
• NHS England and OHID regional colleagues
• Community Stop Smoking services
• University of Sheffield (evaluation partner)
• Yorkshire Cancer Research
• Children’s Hospital Trust
• Acute and Mental Health Trusts

• 85% of eligible admissions across South Yorkshire trusts have smoking status recorded
• Over 1,900 people to stop smoking, which equates to 950 smoking-related deaths avoided
• Over 12,000 specialist assessments conducted with smokers to provide them with information on appropriate nicotine replacement therapy (NRT)
• Mental health trusts embedded tobacco treatment on their Community Mental Health pathways

• ICB commitment to prevention and reducing smoking prevalence
• Trust-based partnership
• Executive ownership of the programme at Trust level
• Consistent reporting mechanisms and datasets
• A focus on prevention within healthcare
• Funding support from Yorkshire Cancer Research (£1.8m over two years) and ICB investment significantly above the NHSE tobacco allocations

• Derby City Council
• Derbyshire County Council
• Local public health teams
• NHS Trusts
• GPs
• Community Pharmacies
• Voluntary and Community Sector organisations

• Strong relationships across the system, particularly between public health teams and the ICB
• Local strategy and delivery plan agreed to focus efforts and resources where needed the most
• Influenced policy and governance structures
• Principles of proportionate universalism adopted, ensuring a large number of delivery sites were upheld, overcoming operational challenges and acknowledging differences with other systems
• Links to Public Health Behavioural Insights Team in Derbyshire County Council brought significant benefit in targeting communications and Making Every Contact Count interventions
• Joint decision-making on budget expenditure to ensure inequality interventions could take place
• Overall approval of provider governance principles for grant funds to be used for both COVID-19 and Measles work
• Specific inclusion group outcomes:
• Flexible response: dedicated clinics in areas of low uptake to target specific populations
• People with Serious Mental Illness and Learning Disabilities: use of agreed funding for a Hyperlocal service and Health Positive service. Health Positive is working with people with SMI and LD in the most deprived areas of Derby and Derbyshire, supporting them to get health-checks and vaccinations. Hyperlocal service offers bespoke conversations to support patients to make informed decisions about vaccination and personalised access, if uptake of vaccination is chosen
• People with Learning Disabilities: development of accessible, visual social stories to provide confidence and clarity on what to expect during a vaccination appointment
• Black Communities: understand barriers to vaccinations and build trust within communities to help them make informed decisions on all lifecycle vaccines and embedding community connectors within communities in Derby City to support the wider and social determinants of health and Core20+5 work
• Rural deprivation: community and voluntary sector organisations undertook a series of engagement events to understand vaccine barriers, concerns and confidence amongst populations in Bolsover
• Communications: targeted and relatable communication campaigns directed at specific populations and cohorts, such as 'at risk' groups and over 65s
• Asylum Seekers: promotion of MMR vaccination sessions

• Willingness to teach and to learn
• Shared purpose and vision – all on the same page
• Shared budget
• System-level governance
• Public health expertise
• Public health leadership of VIG
• Regular, informal catch-ups between ICB and public health leads

The three Directors of Public Health worked closely together to define a strategic framework for engagement and influence across the ICB. Joint public health team workshops helped refine the approach, develop matrix cross team working, and sense making in a constantly changing culture. They clarified their ambitions to have an impact and make a difference in improving health care and health outcomes, and reducing inequality. 

An example across Devon and Torbay is the collaborative approach they are undertaking to help solve the non-contraceptive issue with long-acting reversible contraception (LARC) as a result of waiting lists in the area.

They have developed a co-commissioning pathway and funding arrangements with the ICB to utilise the public health sexual and reproductive health contract to support the delivery of additional sessions to help the ICB with their LARC capacity issues, but doesn’t materially impact, degrade or compete with the public health commissioned provision.

Strategy

DPH led system team devised and developed an Integrated Care Strategy and designed a framework that combines embedding prevention with empowering communities and encouraging organisations to work differently.

Healthcare Public Health Memorandum of Understanding (MoU)

The ICB also developed of a new agreement that shows how and where public health technical skills are supporting the system – both at leadership level by supporting the NHS Joint Forward Plan, and at task level when population health commissioning programmes are being developed.

In 2020, there were 207,198 adults living with some (including severe) hearing loss in Worcestershire. Evidence suggests that hearing loss is linked to cardiovascular disease, stroke and obesity, diabetes, and increased risk of anxiety, depression and other mental health issues. Locally, several independent pieces of community engagement were taking place across the ICS. Public Health teams brought together partners across the ICS to share findings, identify opportunities for action, and develop a strategic approach to removing barriers to access.

Active case finding for M. Tuberculosis (TB) in high-risk populations is a strategy advocated by World Health Organisation. The ICB carried out an active case finding of factory workers after three cases of TB were linked by epidemiological analysis to a small-town factory setting. The multi-agency incident management team (IMT) led by the UKHSA, requested NHS Lincolnshire ICB and the community TB nursing team to screen two high-risk factory areas where 292 employees worked, as identified via onsite visit and risk assessment.

This strategic decision underscores a commitment to addressing potential health risks within the community while adhering to established national guidelines and Lincolnshire protocols for outbreak management.

Lipid Optimisation in secondary prevention of CVD

Analysis by the North-East and Yorkshire Analytics Team identified that people from the most deprived communities living with cardiovascular disease (CVD) were less like to have their cholesterol managed than compared to people living with CVD in the least deprived communities.

South Yorkshire partners came together to discuss what interventions could be introduced to reduce the lipid optimisation health inequalities experienced in South Yorkshire. A plan was developed which included the creation of a local incentive scheme, developing a programme of education for primary care clinicians, and increasing secondary care capacity.

Developing a Population Outcomes Framework

As part of the ICS strategy development, partners agreed that a population-based Outcomes Framework was needed to ensure that the impact that the ICS is having on the health of local communities could be tracked. The ICB agreed to develop a set of metrics for a joint forward plan that would directly align to the ICS strategy goals and ambitions.

'Walk with Us'- A Toolkit for Supporting Children, Young People and Families Affected or Bereaved by Suicide

South Yorkshire and Bassetlaw has a higher suicide rate than the England average. The impact of suicide is complex and the effects are profound, not only on the family and friends of the person who has died but also on the wider community. In recognition of the importance that those who are bereaved from or affected by suicide receive the support they need, South Yorkshire and Bassetlaw Public Health Leads and NHS colleagues have been working together to develop a consistent approach which is informed by the experiences of those living within the region.

Population Health Intelligence

The ICB have recruited both a Deputy Director and Associate Director of Population Health Intelligence to strengthen senior level public health capacity both within the board and as part of the wider ICS. The ICB approach is to create a common shared linked data infrastructure for the ICS, which supports a range of activities from performance assurance to service planning, population health management and outcomes reporting. 

The public health input includes brokering access to data from wider system partners, with the aim of flowing record level data on wider determinants into their shared data environment (including social, care, housing, police etc.). 

HNY Leading the Way to a Smoke-Free Future

The Humber and North Yorkshire Health and Care Partnership launched a comprehensive tobacco control program to address smoking as a major contributor to health inequalities: HNY Tobacco Control Centre for Excellence. The program involves a partnership between the NHS, local authorities, voluntary sector organisations, and academic bodies.

Strategies include coordinated population-level interventions such as tackling illicit tobacco, mass media campaigns, and joint advocacy for effective national policy. The ICB utilises health inequalities funding to finance the program, aiming to become a Centre of excellence for ICS-level tobacco control.