Improving population health is one of the top priorities for Integrated Care Systems (ICSs)¹. Given the unique relationship between clinicians and patients and their respective understanding of the local health context, both have an opportunity to support, influence and lead on population health interventions². What is less clear is the role of acute NHS trusts in supporting population health improvement within their own service and across the care system.

60% of individual or community health status is related to social determinants³, therefore, it is increasingly difficult to think about improving patient care within hospitals without considering population health more broadly. Whilst there are a range of NHS, Health Education England and externally accredited population health resources and training opportunities available for healthcare professionals^4,5,6; local training and support within NHS trusts appears to be less readily available. Although the importance of population health is increasingly recognised following the NHS long-term plan and Core20PLUS5 agenda, there is potential for a policy to practice gap within NHS trusts.  Furthermore, the 2013 Marmot⁷ review highlighted the need for effective participatory approaches that involves local communities, a view widely held as the gold standard for improving population health and reducing health inequalities.^8,9,10,11. Strategic and organisational leadership are therefore required to better understand the role of NHS trusts when it comes to population health within their organisation and wider local context; to embed a culture of person and population centred health care improvement; and in the design, delivery and evaluation of services.

A recent Kings Fund article outlining clinician perspectives on leading for population health¹ identified meaningful partnerships and ability to establish networks as key levers of success¹. Individual and organisational challenges include uncertain politico-economic landscape, time and resource constraints, competing priorities and siloed working¹.  Accordingly, healthcare professionals’ often develop partnerships independently and  more often than not, their population health work isn’t formally recognised. In the absence of a coordinated trust level population health strategy, healthcare professionals’ interested in population health may struggle. Potential challenges include establishing networks, developing relationships with colleagues already taking a population health approach as well as other key stakeholders. Conversely, stakeholders may struggle to find sought after clinical expertise for community-based initiatives without a mechanism by which to develop relationships with expert clinicians. Whilst there are some good examples of NHS trusts working collaboratively and prioritising population health within their own strategic directives^12,13, alongside high-level institutional commitment, it is equally important to ensure that there is a clear pathway for healthcare professionals’. Local contextual population health training, mentorship and support, with recognised time for population health activity will create the desired culture, meet strategic objectives and ultimately improve patient outcomes. Leveraging the role of NHS Trusts as anchor institutions may also provide an opportunity for that mechanism to be developed, while simultaneously facilitating the development of participatory approaches with patients and communities.

Establishing an actionable population health strategy and operational framework to engage and support clinicians, patients and communities is one way to embed a population centred approach within NHS trusts. Another key pillar of population health management where NHS trusts can make a vital contribution is data collection and analysis. Data–driven care planning and delivery can help improve population health through identifying unmet needs, targeting interventions and measuring outcomes¹⁴.  An increasing number of NHS trusts are investing in electronic patient record systems that will harmonise records across the local care system, improve accessibility and facilitate patient–driven service improvement¹⁵. However, it is important to remember that accuracy and meaningful interpretation relies on robust data collection and analysis. NHS trusts need to invest in sufficient data analyst expertise to support the scale-up of data-driven service improvement.  More broadly, harmonising electronic patient records across the care system isn’t by itself sufficient to fully understand and improve population health.  A multi-sectorial approach to data sharing is required to fully appreciate the impact of wider determinants on health. Clinicians would certainly benefit from population level intelligence that may include local socio-economic demographic data and wider environmental and cultural contexts. Conversely, local councils may benefit from trust level data on hospital admissions, morbidity and mortality to better understand the health needs of their local population¹.

NHS trusts play a pivotal role in supporting population health improvement within their organisations and ICSs. A clear population health strategy that includes engaging and supporting healthcare professionals’ as well as patients and communities will help embed a culture of person and population centred care across services. Trusts may want to consider establishing “population health hubs” within their organisation, with a designated team to support training and education with a particular emphasis on increasing understanding of participatory approaches, while supporting the strengthening of internal and external networks across sectors. Securing data analytics expertise to support and strengthen data driven care in collaboration with stakeholders across sectors should be another key strategic priority. Despite the perpetual financial and wide ranging resource pressures facing NHS trusts, perhaps a paradigm shift is required where sustained financial and human resource investment into population health and prevention has the potential to reduce pressures, improve efficiency and cost effectiveness and most importantly improve health and well-being of local populations.

References

1. https://www.kingsfund.org.uk/publications/leading-population-health-clinicians-perspectives
2. https://www.kingsfund.org.uk/publications/place-based-partnerships-explained#what-are-they
3. Determinants of Health Visualized (goinvo.com)
4. https://se.leadershipacademy.nhs.uk/development-opportunities-and-support/primary-care/population-health-management-masterclasses-coming-soon/
5. https://www.hee.nhs.uk/our-work/population-health/our-resources-hub/nhs-population-health-training-pathways
6. https://www.kingsfund.org.uk/courses/leadership-population-health?gclid=Cj0KCQjwwvilBhCFARIsADvYi7I-oKKgNrhryEexeRdhekig6bSgbDdOT3rbEb22kzxZbnNvssWGWIUaAr6aEALw_wcB
7. https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on?gclid=Cj0KCQjw6KunBhDxARIsAKFUGs810sQhnLZuwk_AgTT9m5zJnIPHem9e1jPIoT7YzzicArP5qzPnvwgaArFCEALw_wcB
8. WHO (2020, October 5^th). Community engagement: a health promotion guide for universal health coverage in the hands of the people.
9. The King’s Fund, Communities and health (2021) https://www.kingsfund.org.uk/publications/communities-and-health (accessed November 2022)
10. O’Mara-Eves, A., Brunton, G., Oliver, S., Kavanagh, J., Jamal, F., & Thomas, J. (2015). The effectiveness of community engagement in public health interventions for disadvantaged groups: A meta-analysis. BMC Public Health, 15(1), 129. https://doi.org/10.1186/s12889-015-1352-y
11. Yuan, M., Lin, H., Wu, H., Yu, M., Tu, J., & Lü, Y. (2021). Community engagement in public health: A bibliometric mapping of global research. Archives of Public Health, 79(1), 6. https://doi.org/10.1186/s13690-021-00525-3
12. https://www.kingshealthpartners.org/our-work/population-health-and-equity
13. https://www.kingshealthpartners.org/our-five-year-plan-2020-2025
14. https://www.england.nhs.uk/integratedcare/what-is-integrated-care/phm/
15. https://www.guysandstthomas.nhs.uk/about-us/our-organisation/our-future

Authors

Dr. Ahmed Seedat, MBBS, BSc, MRCP (UK) (Respiratory Medicine)

Ahmed is a Respiratory Consultant and policy fellow at the Policy Institute at King’s, currently undertaking a Masters in Public Health with a keen interest in global health and healthcare leadership.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none

Simon O’Donoghue

Simon is currently Head of Equality, Diversity and Inclusion (Patients and Communities) at King’s College Hospital Foundation Trust. He plays a key role in leading King’s Trust wide approach to tackling health inequalities and recently co-authored a journal of Public Health in Practice article that proposed a framework for increasing minority ethnic participation in research. He has also introduced a new model for community engagement and innovation, which is helping to ensure solutions to health inequality challenges are informed and co-designed with South East London’s diverse communities.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none