Health leaders focus too much on waiting times and financial performance which diverts attention from population health and long-term goals, according to a new report from The King’s Fund.
The report looked at the ways in which population health is tackled in Greater Manchester ICS, as it is often the ‘poster child’ for devolution in England and has led efforts to improve population health at scale.
The research undertook three case studies from Greater Manchester, as well as reviewing existing literature, and found that this focus on population health was ‘starting to pay off’, with greater improvements than what would have been expected on key measures of health and health inequalities.
For example, increases in life expectancy were seen in eight of ten local authorities in the period from 2006 to 2019, with these uplifts larger among men than women, and in areas of high income deprivation compared to low income deprivation. These results ‘diverged positively from what would be expected after its devolution settlement’.
Using the example of Greater Manchester ICS, the report gave several recommendations for different levels of leadership to help improve efforts on population health, including the Department of Health and Social Care (DHSC), the government and ICSs.
This included calling on DHSC and NHS England to ‘reiterate that population health is a core goal of ICSs’.
‘This requires consistent strong messaging from ministers and the leaders of the NHS that population health is a core goal for ICSs,’ it said. ‘The leadership focus and action are too heavily skewed towards waiting times and financial performance, which diverts leaders’ attention away from long-term goals for population health.’
It also called for accountability systems and supporting tools to be focused on population health, and to reward action on it.
‘The existing accountability structures and focus are too heavily weighted towards financial and performance goals,’ it said.
‘This acts to skew effort, and reward for effort, away from the other founding principles of ICSs – improving population health and tackling health inequalities – and the wider contribution that ICSs make to the economies and societies they are part of. This needs to change.
‘DHSC and NHSE must rebalance accountability systems and tools towards those goals, for example through specifying that ICS shared outcomes frameworks emphasise and include the four pillars of population health and the role of the NHS and its partners in delivering them.’
The report also recommended that ICSs:
- Develop a widely owned vision and adopt a clear but flexible framework or model to help cohere efforts in service of it,
- Be consistent in approach over time,
- Ensure clarity over system-level and local roles and reflect this in governance,
- Constantly learn, develop and build capability for population health,
- Be open to external bodies and the support they can offer,
- Lead and act on the knowledge that population health and health and care system goals are intertwined and codependent,
- Lead and act on the knowledge that population health and economic goals are intertwined and codependent.
The report said: ‘Since the creation of ICSs, there has been consistent central focus and attention on finances and service goals, such as waiting times, to the detriment of important ambitions such as improving population health. ICSs have also lost capability and bandwidth due to funding cuts. This has diverted leadership and management attention away from fulfilling the principles underpinning their creation, including on population health.
‘The new government has an opportunity to reset this, and to better support the development of population health systems through creating better conditions for ICSs, and through ensuring that population health approaches underpin its approach to its health mission and connect with its wider approach to devolution in England.’
It comes as ICBs have reported saving £25 million through redundancies since they were first set up in 2022.
