In the third article in our series on public health, Kathy Oxtoby looks at how West Yorkshire ICB has embedded public health into its system to improve the health of its population.
West Yorkshire ICB established a public health function called Improving population health in 2019, which has grown in size and remit reflecting the growing needs of the organisation.
It now covers all aspects of population health “at scale” for a population of 2.4 million.
‘Our vision is to embed a culture of improving population health and reducing inequalities through increasing system capacity, capability and intelligence,’ says Sarah Smith, deputy director of improving population health at West Yorkshire ICB.
She says she is ‘fortunate to work in an ICB that values and invests in public health leadership and we have a public health function embedded within the organisation’.
Over the past five years, the team has demonstrated the value of public health input into ICSs, she says.
‘Led through our 10 big partnership ambitions we have a strong commitment to reducing health inequalities.
‘We have supported system capability related to population health through the establishment of a health inequalities academy for West Yorkshire and a West Yorkshire inclusion health unit,’ she says.
‘One of the elements of this we are most proud of is the improving population health fellowship, where we have welcomed over 150 fellows from across the West Yorkshire system to undergo public health training alongside protected time to deliver a population health project. We have also worked with partners such as charity Fairhealth who provide excellent training materials for primary care and other health service colleagues to understand the role they can play in reducing inequalities,’ she says.
‘We have advocated for equitable allocation of resource in West Yorkshire evidenced by our use of CORE20Plus5 resource which was distributed based on need weighted by deprivation. This enabled some targeted initiatives in primary care including those led by the Bradford Reducing Inequalities Alliance, who took an intelligence led approach to targeting preventative interventions to address healthcare inequalities in local neighbourhoods,’ she says.
Equitable access to care
From a population health perspective ‘one of the specific challenges we are working to address is equitable access to primary care’, says Ms Smith. ‘This inequality is often experienced most starkly for inclusion health groups.’
Population groups such as Gypsies and Travellers, Roma communities, vulnerable migrants, people experiencing homelessness and sex workers can often be unregistered and therefore “invisible” to services, she says.
‘Colleagues in Bradford have supported the wider system through conducting a health needs assessment to help us quantify under-recorded populations and the health challenges they are facing.’
She says there are ‘clear opportunities for public health and primary care colleagues to join forces to improve outcomes for these communities’.
‘As an ICB we have been working closely with Leeds Gypsy and Traveller Exchange, Leeds GATE to improve access for the community into primary care services.
‘We were the first ICS to become a partnership of sanctuary. This included support for primary care networks to undertake safer surgery training, to help improve access and quality of primary care for people seeking sanctuary.’
Population health management
Another area where primary care and public health are closely aligned is the use of intelligence to develop population health management approaches.
‘This is something that was clearly identified within the NHS England integrated neighbourhood health guidelines, so will be an area we continue to develop over the coming years and months,’ says Ms Smith.
Ms Smith adds that they are ‘advocating for a focus on the determinants of health that will underpin the shift from treatment to prevention’.
One example of this is the link between access to fair work and good health, with West Yorkshire being one of three work and health accelerator sites announced in November 2024 to address the health drivers of economic inactivity.
The ‘trailblazer’ project is set to receive £37m between April 2025 and April 2026, with the ICB getting £11m of that. The rest of the funding will be split between the West Yorkshire Combined Authority and local authorities delivering a Connect to Work programme.
‘Primary care are key partners in our approach to both identifying people at risk of falling out of work and supporting them with bespoke interventions that will keep them healthy enough to remain in employment,’ she says.
