Session 6: NHS – neighbourhood health services?

Informed by the latest OCSI research, this session will look at the real state of health of residents of ‘left behind’ neighbourhoods, one year from the start of the lockdown. It will help provide a better understanding of the longer-term impact of COVID-19, and explore what sort of hyper-local initiatives and neighbourhood-based preventative healthcare measures can help improve people’s physical and mental wellbeing.

Our speakers

• Clare Bambra, Professor of Public Health, Newcastle University
• Christina Gray, Director for Communities and Public Health, Bristol City Council
• Sharon Barnes, Chair, and Kate Whitmarsh, Development Officer, Ewanrigg Big Local​

Briefing

APPG Session 6 Health briefing

This briefing provides members of the All-Party Parliamentary Group for ‘left behind’ neighbourhoods with an overview of health outcomes in ‘left behind’ neighbourhoods, the challenges faced by local residents and the role that local communities can play in tackling health inequalities.

OCSI health data dive for the All-Party Parliamentary Group for ‘left behind’ neighbourhoods

A ‘data dive’ research report for the All-Party Parliamentary Group for ‘left behind’ neighbourhoods into the health characteristics of ‘left behind’ neighbourhoods.

Context

Place-based health

• Get well soon: reimagining place-based health: the place-based health commission report. New Local and Collaborate (2016).The main output from the commission on place-based health, this report makes the case that geographical inequalities are major risks to population health. It then sets out a radical new health and wellbeing system to begin to address this – bringing together the NHS, local government, the voluntary and community sector, housing providers and other local services to confront the main drivers of poor health in neighbourhoods.
• Build back fairer: the COVID-19 Marmot review. The Health Foundation (2020).One month after ‘the Marmot Review ten years on’ was published, the COVID-19 pandemic unleashed its full force. The pandemic has further exacerbated existing health inequalities, revealed most plainly by the socioeconomic and ethnic inequalities in risk mortality from the disease. This report contains detailed proposals – in the short, medium and long term – to ensure that our communities are built back stronger, fairer and more resilient post-pandemic.
• Health equity in England: The Marmot review ten years on. Institute of Health Equity (2020). This report explores what has happened to health inequalities and social determinants of health in the decade since the Marmot review. After a deep exploration into the current state health in England, it provides a detailed agenda for the Government and local authorities, which includes place-based recommendations to build and develop more empowered and sustainable places and communities.

Community-led health improvement

• What makes us healthy? The asset approach in practice. Jane Foot (2012).This report sets out the evidence on social capital, social networks and health, and how they can build the resilience of individuals and communities to ill-health. It then outlines core principles upon which government and related organisations should build ‘asset approaches’ to health improvement. Approaches must be: asset-based; place-based; relationship-based; community-drive and focused on driving social justice and equality.
• A guide to community-centred approaches for health and wellbeing. Public Health England and NHS England (2015).Drawing together research on community-centred approaches to health improvement, this project reveals that an ‘asset based approach’ would better enable the NHS, local government and other partners to harness the skills, knowledge and social networks that already exist within communities to boost health and wellbeing outcomes. Better support for community engagement, increasing social connection and giving residents a better say in local decisions are all found to be factors that improve health and wellbeing.
• Effects of participation in community assets of quality of life and costs of care: longitudinal cohort study of older people in England. British Medical Journal (2020).This study reveals that participation in community assets, defined as charity, voluntary or community groups, is associated with improved quality of life. Over the long term, it also generates a ‘net benefit’ as the benefits of higher levels of participation (measured by reductions in health care costs) outweigh the costs of investment in community assets (Munford et al, 2020).  It therefore proposes that community assets are included as part of furture  integrated care models for older patients.
• Impact stories: health. Nesta (2020).This series of case studies provides a window on what the health and care system could look like if people and place were at its heart. From The Cares Family in Liverpool, a group which brings older and younger people together to share time, make connections and support one another, to the early intervention approach to mental health spearheaded by the Lambeth Living Well Collective, they are an inspiring collection of stories where individuals and communities have been empowered to have better control over their health and wellbeing.

Current policy and approaches

• A citizen-led approach to health and care: lessons from the Wigan Deal. The King’s Fund (2019).  Since 2012, Wigan Council has transformed its approach to local service delivery, building a new relationship with the public widely known as the ‘Wigan Deal’. This has included working with communities, the NHS and other partners to develop a radical approach to improving health and wellbeing. This report shows that such an approach, ‘working with’ rather than ‘doing to’ communities, leads to better health outcomes for citizens.
• Building healthier communities: the role of the NHS as an anchor institution. The Health Foundation (2019). Widening health inequalities and ongoing conversations about the role that the NHS must play in prevention and early intervention, leads this report to explore the wider influence of the health service in local communities. It sets out a vision for NHS to be effectively ‘anchored’ within each community, maximising the social and economic value it brings to people and places.
• The NHS Long Term Plan. NHS England (2019).The NHS Long Term Plan, published January 2019 sets out key ambitions for the health service over the next decade. One of the headline commitments is to shift care away from hospitals and closer to people’s homes and communities. This involves the establishment of ‘primary care networks’ tasked with taking a proactive and tailored approach to improving local health and wellbeing, as well as plans to develop ‘full integrated community-based health care’.
• Public Health England Strategy 2020-2025. Public Health England (2020). The strategy provides a roadmap for how PHE aims to protect and improve the public’s health over the next five years. The Strategy aims to move beyond reactive, curative forms of healthcare towards prevention and early intervention approaches. To enable this, there are steps towards building more ‘connected, resilient, cohesive communities’, with PHE, local authorities, the NHS and community organisations working in collaboration to empower residents to have ‘a greater say in their lives and health’.  
• Integration and innovation: working together to improve health and social care for all. The Department of Health and Social Care (2021). The health and social care white paper aims to ‘empower local leaders and services and tackle health inequalities’ through reducing legislative bureaucracy. It has also been welcomed by commentators due to a shift towards collaboration – both within separate NHS departments and between the Health Service and its external partners. 
• ‘Not the health white paper the country needed’. Adam Lent (2021). Adam Lent, Chief Executive of think tank New Local, argues that the recent health and social care white paper does not meet the medium to long-term challenges faced by the NHS. For him, it falls short due no mention of: empowering communities to take control of their health outcomes, challenging organisational culture to truly boost collaboration, and shifting healthcare from hospitals to homes and communities. 

 

An APPG report and recommendations will be produced after this session.