Building healthier accountable communities

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Over the past few decades England, like other countries, has worked hard to improve the health of its population largely by focusing on health care services – an approach that has not achieved better health for all. At our annual integrated care summit last week we heard from international and national speakers about how they are adopting a more systemic and integrated approach to improving population health. Three important messages emerged from the day.

First, the need for commitment and action from a range of different sectors who are signed up to improving population health and wellbeing. This was reinforced by Alonzo Plough from the Robert Wood Johnson Foundation who spoke of a new programme the Foundation is supporting to build a ‘culture of health for all’ in the United States. The programme calls for broad collaboration between governmental departments, statutory and non-statutory organisations as well as individuals, families and local communities. Creating a national movement towards better health will take time and input from many. 

The Foundation, together with the RAND Corporation, has developed an action framework to support the range of activities needed to improve health and wellbeing. These are: fostering cross-sector collaboration; creating healthier, more equitable communities; making health a shared value; and strengthening integration of health services and systems. The programme will be supporting a long-term process of change without identifying solutions in advance. The objective is to create and sustain collective processes, develop useful measures, and nurture a more collaborative style of leadership that will enable cross-sector relationships to thrive. We will be working closely with the Foundation over the next few years to follow the impact of its programme – if successful, it will lead to large-scale change across the system.

And, back in the United Kingdom, the Fund is launching its own programme that looks to work with six communities across England that are committed to working across sectors and with patients and the public to improve population health and wellbeing. At this stage we are inviting initial expressions of interest to be submitted to Further information will be available in early December and the programme will start in April 2016.

Second, there was a great deal of focus on the need to develop place-based systems of care, collaborating across organisational and service boundaries to meet the needs of a defined population. Many approaches are being developed; new system leadership groups are being established across counties, and in other places, such as Ilfracombe in Devon, a more local approach is being taken. All public services in the town have worked together and formed a not-for-profit organisation – One Ilfracombe. Over the past two years, the organisation has worked with local residents to achieve greater service integration and provide people with more support at the ‘wobble points’ in their lives to avoid a crisis. One Ilfracombe has three teams: the town economy team chaired by the chief executive of a large local employer; the town team chaired by the local police inspector and residents (focused on creating a cleaner, safer and greener town); and the living well team chaired by a local GP. The three teams are leading a range of activities to improve care co-ordination and tackle the broader determinants of health. Together staff and residents are developing a stronger local NHS – a neighbourhood health and wellbeing service.

The need for more productive interactions between patients and their care teams was the third prominent theme at the summit. Professor David Sobel, former medical director of patient education and health promotion at Kaiser Permanente, suggested that we are not paying sufficient attention to the ‘resource of self care’ in current discussions on the new care models set out in the NHS five year forward view. Patients and service users attending the conference agreed with him. So, what more can we do to support people to manage their own conditions? There were lots of ideas and a recognition that patients being more involved in their own care was a constructive force for change in our local care systems. However, this depends on people having the information, power and control to stay healthy, manage their conditions and choose treatments. This will require new and empowering models of care that bring about a fundamental shift of power between care professionals and patients, something the Fund is actively working on.

As two past health secretaries, Alan Milburn and Stephen Dorrell, recently suggested, the NHS needs to stop treating patients as passive bystanders and instead enlist them as active agents of change – perhaps if we achieve this we truly will improve the health of the population.


dr mukund lal

medical officer,
medical and health
Comment date
26 October 2015
hi nicola walsh
i read kingsfund uk population health and wellbeing article and find above article is very valuable for us in integrated management of health care and wellbeing.thanks

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