ICSs have too many targets that ‘constrict’ progress on inequalities, according to a new report by NHS Confederation and the Institute for Public Policy Research (IPPR).
The Unleashing health and prosperity throughout Britain report found that the gap in health life expectancy, which is the number of years a person can expect to live in full health, was now over 20 years between the healthiest and least healthy local authorities across Britain.
It said that while one of the key strengths of ICSs is an increased level of autonomy, that ‘local systems are still subject to a proliferation of targets’ that end up ‘constricting change’. It called for a smaller set of outcome-driven targets to address the widening health expectancy gap.
The report said: ‘Devolving power might benefit from the centre reconsidering its control architecture. Despite rhetoric on subsidiarity, local systems are still subject to a proliferation of targets. In turn, those targets tend to be focused on acute rather than preventative outcomes, constricting change.
‘In line with the Hewitt review, a smaller set of targets may be beneficial in creating space for change.’
One ICP chair said in the report: ‘The message to government needs to be ‘don’t box us in via a national agenda and targets that don’t make sense locally. Work with us and through us.’
The report looked into the variation in economic activity due to sickness between the healthiest and least healthy parts of Britain using healthy life expectancy and Labour Force Survey data.
It found that less healthy local authorities consistently had higher economic inactivity due to sickness rather than the healthiest. For example, in the least healthy part of Britain, Blackpool, where healthy life expectancy is under 55 years, 15% of women and 13% of men were inactive due to sickness. But in Wokingham, one of the healthiest with a healthy life expectancy above 70, economic inactivity due to sickness was around 2% for both men and women.
It suggested that health and prosperity was a ‘highly localised’ issue which meant ‘targeted’ place-level system working would be ‘a key part of the solution’.
The report also engaged with four ICSs (West Yorkshire, North East London, Sussex and Coventry and Warwickshire) and one Welsh local health board to understand how they are working towards their ‘fourth purpose’ to support social and economic development.
The authors called for better sharing of resources and ideas across partners, including beyond the health service.
It said: ‘Many of the issues that are most important for the long-term social and economic development of a place are thorny, with responsibilities spanning across various sectors. Addressing homelessness, tackling food poverty and improving civic pride are all examples of cross-cutting challenges that require a common, shared focus among cross-sector place leaders if inequalities are to be narrowed.’
It added that there is a challenge when it comes to prioritisation, measurement and assessment, but that leaders should ‘have the confidence’ to determine what is best for their areas.
The report said: ‘The most impactful things for a local place are likely not valued by national NHS leaders, and what NHS England values the most probably would not have the same impact in a local area.
‘Leaders should have the confidence to determine what is best for their areas and to act accordingly; sharing, experimenting, challenging each other and evidencing upwards. This might mean starting new conversations, but it also might mean inviting local system partners to join existing discussions.’
Matthew Taylor, chief executive of NHS Confederation, added: ‘It is my hope that as the government places this agenda at the forefront of its policies surrounding health and growth, the NHS’s power as an anchor institution progresses from theory to practice, and that leaders are given the space, budget, autonomy and time to drive their respective health and growth agendas. It is evident that leaders have a will to do this. Now is the centre’s time to give them a way.’
Earlier this year, the Institute of Health Equity found that life expectancy inequalities have increased for both men and women, with the largest increases in the North East of England.
