There is tension and a lack of engagement between public health and ICS leaders, according to a new report from The King’s Fund.
The report, called Public Health and Population Health: Leading Together, looked at how the system currently works together through case studies, interviews and roundtables, and set out a number of recommendations for change and principles of practice.
It found that while there was a ‘general sense’ that ICSs’ focus on population health could be a positive development, that they need greater support and more clarity on their roles.
Some claimed that individuals moving from a public health leadership role to a population health leadership role within the ICS would be a ‘drain’ on the public health profession, moving knowledge away from where it was ‘most needed’.
The report found that people wanted a ‘clear vision and leadership’ of public health and population health principles, and greater clarity and distinction between the two, and recommended this was provided (see box for recommendations).
It said: ‘The biggest and most contentious issue we heard about was a search for clarity on the concepts and definitions of population health, and how population health relates to public health.
‘The issue with these often-unspoken disagreements about language is not that one group is right and other groups are wrong. The issue is that the lack of a shared understanding leads to confusion, preventing effective system working and sometimes causing mistrust between colleagues in different roles.’
It added: ‘This lack of clarity gets in the way of good work, practice and intentions and, in our view, powerful joint leadership communities operating across the boundary of the NHS and local government to improve the health of the population and tackle health inequalities,’ said the report.’
Report recommendations
- Provide clarity on the definition of population health (and its relationship with public health) and a facilitative framework for responsibilities and roles.
- Provide medium- to long-term commitments on population health resources and public health capacity.
- Allow structures to mature and reaffirm the principles of ICSs.
- Actively share emerging practice and experience.
Source: The King’s Fund
The report also set out six principles for colleagues to lead and work together across the two areas:
- Remain focused and lead for population health outcomes
- Develop a shared understanding of the conceptual and practical differences between public health and population health in your system
- Be explicit about who will lead on what through the ICS and other levels
- ‘Start somewhere, follow it everywhere’
- Pay attention to and support public health and population health workforce wellbeing
- Plan for, and commit time to, being together beyond the day-to-day.
David Buck, senior fellow at The King’s Fund said: ‘The new government has committed to halving the gap in healthy life expectancy between the richest and poorest regions of England. This goal cannot be achieved from Whitehall alone. It will be of paramount importance to create the right support and conditions to enable strong, effective and cohesive public health and population health leadership at a local and regional level.
‘While good practice is happening in places around the country, our research into how leaders in public health and population health work together found that tensions and a lack of engagement between public health and population health leaders remain in some areas.’
He added: ‘Their effectiveness could be enhanced by greater clarity on definitions and guidance on roles, sharing examples from good practice and greater investment in capacity and capability.
‘The government and national bodies will have an important role to play in creating an environment conducive to their success, including by providing clarity on role definitions and a clearer framework for these leaders to operate in.’
Last month, Emma Adams, head of integration and partnerships at Coventry and Warwickshire ICB spoke of how population health management works in practice within the system.
