We have made a commitment to reduce health inequalities through improving access, experience, and outcomes. This means we will focus on:

• preventing people from becoming ill in the first place by tackling the wider determinants of health (the diverse range of social, economic and environmental factors which impact on people's health);
• supporting people to make positive health and wellbeing choices;
• improving access, experience, and outcomes of health and care services.

We approach this work in partnership with our colleagues in local government, the wider public sector, the voluntary, community, faith and social enterprise sector (VCFSE), and – importantly – with the people and communities we are here to serve. This partnership approach is crucial to ensure we fully understand the challenges faced in our neighbourhoods and also to connect with the unique and valuable assets rooted in our communities.

Our strategy is ambitious and is a long term commitment. Based on national and international evidence, we know that some of this work will not deliver results for years to come, but we have to start now.

Our plan is to:

1. Work with people, communities and our partners to address the factors that lead to poor health (eg improving educational attainment, housing and employment  – we know this work may not demonstrate significant impact in the short term but it is important to start now so that we will start to see impact over decades to come
2. Improve detection and diagnose illness sooner (eg stop smoking, improve access to health checks and screening) – we may start to see impact form this work in the medium term (8-10 years)
3. Ensure that people with a disease receive the care that they need to avoid unnecessary exacerbations (eg managing cardiovascular disease)  - the impact of this work is more visible in the short term (3-5 years)

Within the NHS we must also have a constant focus on addressing inequities in NHS services and to increase our focus on prevention. NHS England has published two national frameworks to support the reduction of healthcare inequalities – one for adults and one for children and young people. Known as ‘Core20Plus5’, these frameworks set out an overarching approach and targets that we use to guide our work here in Lancashire and South Cumbria.

Core20

‘Core20’ refers to the most disadvantaged 20% of the national population as identified by the national Index of Multiple Deprivation (IMD). The IMD has seven domains with indicators accounting for a wide range of social determinants of health: income, employment, health disadvantage and disability, education skills and training, crime, housing, and living environment.

Plus

‘Plus’ refers to those communities and groups that experience poorer than average health access, experience and outcomes, and who may not be captured by ‘Core20’ alone. Plus communities differ across Lancashire and South Cumbria; different places will identify and prioritise different groups. They can include:

• Black and Ethnic minority communities;
• People with a learning disability and autistic people;
• People with a physical disability;
• People with multiple long-term health conditions;
• Groups that share protected characteristics as defined by the Equality Act 2010; such as age, gender, sexual orientation, or religion/belief.

‘Plus’ communities also include inclusion health groups such as: people experiencing homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system, victims of modern slavery and other socially excluded groups.

5

‘5’ relates to five clinical areas of focus that require accelerated improvement. Governance for these five focus areas sits with national programmes; national and regional teams coordinate activity across local systems to achieve national aims.

1. Maternity - Ensuring continuity of care for women from Black, Asian and minority ethnic communities and from the most deprived groups. This model of care requires appropriate staffing levels to be implemented safely.
2. Severe mental illness (SMI) - Ensure annual physical health checks for people with SMI to at least nationally set targets.
3. Chronic respiratory disease - A clear focus on Chronic Obstructive Pulmonary Disease (COPD) driving up uptake of COVID, flu and pneumonia vaccines to reduce infective exacerbations and emergency hospital admissions due to those exacerbations.
4. Early cancer diagnosis - 75% of cases diagnosed at stage 1 or stage 2 by 2028.
5. Hypertension case-finding and optimal management and lipid optimal management - To allow for interventions to optimise blood pressure and minimise the risk of myocardial infarction and stroke.

Our approach to delivering on the targets contained within Core20Plus5 is to be delivered in tandem with five key strategic priorities all ICB’s must undertake:

1. Restore NHS Services inclusively: In our work to improve waiting times and recover from COVID-19 we must ensure improve equity, rather than continuing historic inequities.
2. Mitigate against digital exclusion: whilst digital access provides enormous opportunities for us, we must ensure that we ensure it doesn’t disadvantage some people.
3. Ensure datasets are timely and complete: this includes a particular focus on improving data regarding ethnicity; unless this data is accurate and complete we can’t tackle the huge inequities that we know exist between ethnic groups.
4. Accelerate preventative programmes: Preventative programmes and proactive health management for groups at greatest risk of poor health outcomes using a progressive universalism approach so that preventative services reach a greater proportion of people who are most likely to face the worst inequities.
5. Strengthen leadership and accountability: every NHS organisation in Lancashire and South Cumbria now has a board-level lead for health inequalities. We are working with these leaders and with our partners to spread knowledge and understanding across the NHS so that everyone understands the role they play and has the skills and tools they need.

If you would like to know more about the Core20Plus5 approaches nationally, you can visit the NHS England guidance here: NHS England » Core20PLUS5 (adults) – an approach to reducing healthcare inequalities

The Population Health team leads on the delivery of the ICB’s statutory duties of keeping our population well by reducing preventable ill-health; and reducing avoidable health inequalities in access, experience, and outcomes.

While the population health team is a key enabler to undertaking these duties, success requires collaboration and focus across the whole NHS, in every service and in every pathway.

Our population health framework sets out the different parts of the work and helps everyone see where they can play a role, be it in health creation, early detection of disease, or improving access, experience and outcomes. All of this work involves working in partnership with the people living in our communities and with a wide range of partner organisations.

Our aim is to follow a “proportionate universalism” approach, with a focus on improving the health of those who face the worst outcomes fastest. This framework is being used across the ICB’s work programmes to break down the pathways and to understand where we need to target and plan roles and actions.

Critically, the framework relies on three underpinning key enablers:-

• Data and intelligence: the use of data across our whole system to understand where people are facing barriers to access, having unsatisfactory experience of services and having the worst outcomes. A major part of our enabling work is to improve the use of the data we have and to develop ways to harness the immense power of data to drive this work. For more information about how we use data to help us tackle health inequalities, go to: How we use data to tackle health inequalities.

• Community participation and community power: In order to gain a deeper understanding of the complex factors that contribute to the disparities in health outcomes in different populations we need to listen to people and have conversations about what matters to them. Then we need to work with them and their communities so that together we all play our part to address the things that matter. For more information about how we work with people and communities, go to: Power to the People! How we work with people and communities.
• Resource: ensuring that we put have the financial resources and the people across our system to do this work. Critically this includes providing learning opportunities and developing new skillsets. A key part of this is the development of our Population Health Academy to ensure we spread the knowledge and skills across our workforce. 

The ICB has set out its plans in the LSC Integrated Care Board NHS Joint Forward Plan. The work to target health inequalities and increase prevention is written throughout this plan as one of the key priorities to improving the health and well-being of the people of Lancashire and South Cumbria. More information about the NHS Joint Forward plan can be found here.

Improving the population’s health and preventing illness and disease is at the heart of the NHS Long Term Plan, and tackling health inequalities is a core priority because people from more deprived backgrounds are more likely to have long term health conditions and suffer poor health. Our population health framework and programme of work underpin the ICBs commitment to delivery of the NHS Prevention Programme, which contains a range of initiatives specifically looking at the early detection of disease and support for people taking their own action to better health through supported self-management. More information about the NHS Prevention Programme can be found here.