As of July 1st, the NHS will be managed through a series of Integrated Care Systems. The NHS describes these as “partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.”
Amongst other specific aspects of how ICSs will work, the NHS puts a particular emphasis on “place”:
“within each ICS, place-based partnerships will lead the detailed design and delivery of integrated services across their localities and neighbourhoods. The partnerships will involve the NHS, local councils, community and voluntary organisations, local residents, people who use services, their carers and representatives and other community partners with a role in supporting the health and wellbeing of the population.”
This sounds like good news, and something that local residents will welcome. But how will it operate in practice? And will these partnerships integrate with the planning process as the structure and boundaries of “places” change?
Prof Donna Hall is chair of Bolton NHS Foundation Trust and New Local, and recently spoke to Matthew Taylor of the NHS Confederation about the role of public engagement in the NHS’s Integrated Care Systems. She is an acute observer and seasoned practitioner of community-led models of service delivery:
“We've got to recognise that we need to invest in this type of approach and it's not something that traditionally you find the NHS or local government putting money into prevention, into public health, social care asset-based approaches, into local community and voluntary groups and neighbourhood organisations who can really support people at the grassroots level, that we as a big acute trust, in Bolton, can't get into those local areas.”
And is leading the implementation of a community-led model for health services in Bolton:
“one of the things we've done together is fund a series of community champions in Bolton who are there, speak 30 languages between them and they get out there, they get to know people, they have different conversations with them, they signpost, they advocate, they champion people on their street, and that's the kind of approach that we need in public services. We can't be just waiting in accident and emergency for people to come in crisis.”
Asked about how ICSs will embed some of these principles more broadly across the country, Donna commented
“I'm an eternal optimist and I obviously have worked with NHS England on the guidance to try to make it much more focused on communities and place and I do think it's different to other NHS guidance …..We need to turn ourselves inside out as NHS organisations and councils and we need to operate completely differently, not just sit in our ivory towers and wait for people to come to us. We've got to go out to communities and find out what we need to do differently.”
Like Bolton, there are models integrating placemaking with health promotion being developed and implemented across the country, some led by the voluntary sector, others by local authorities. These include the Bromley by Bow Centre
in east London which combines an extensive neighbourhood hub with a medical practice and a community research project, and the network of regions committed to redressing health inequalities known as Marmot Cities.
The challenge will be to leverage the commitment for integrated care at the NHS level into the practice of building more healthy and engaged places, in some cases joining up existing programmes like Bromley by Bow and Marmot Cities and in other cases creating new community-led initiatives. This presents a massive opportunity for regeneration projects to take an active “health-promoting” approach in local communities rather than the conventional and too-often seen “risk mitigation” approach.
Four things are going on here that underscore the opportunity:
· consensus and awareness about the importance of public health and health inequalities, probably unprecedented at the levels we’re seeing
· a government commitment to reforming the planning system with an emphasis on “levelling up” across regions
· NHS restructuring around ICSs with communities at core – effectively giving permission, encouragement and resource to local community groups to drive local health initiatives
At the very least, these developments are making it increasingly difficult for developers and LPAs to ignore the role of health promotion in planning the built environment and to deliver a “placemaking” approach to urban regeneration. Indeed, as the examples discussed above show, they have the potential to make a big impact on levelling up and reducing health inequalities. Stay tuned.
Listen to Locals
13 June 2022