Delivering population health: lessons for government on implementing plans and missions on the ground

The government is committed to a 10-year health plan and a wider mission for the health of the population. Over the last six years, following the publication of The King’s Fund’s Vision for Population Health in 2018, we have been working in the health and care system and with its leaders and partners on delivering population health. At the heart of this is coherence in bringing together resources and maximising the contributions in local systems across the four pillars of population health: the wider determinants of health; health behaviour change; through communities; and the direct delivery of prevention and care.   

This work has been varied, diverse and practical, working with places and supporting leadership development. Over the last couple of months, we have published two reports and a joint briefing that have important lessons for a government intent on improving the population’s health in practice, and which focus on the real-world implementation of policy at system, regional and local level. If the government fails to pay attention to implementation in its plans and missions, it will fail at worst and be less successful than it hopes at best. So what are the key messages that government needs to hear? 

First, the principles underpinning integrated care systems are correct and we know their leaders want to deliver on population health and health inequalities. At their best, integrated care systems could become true population health systems, helping to integrate far more than care, by being at the nexus of policy and practice on the four pillars of population health, and plugging into and complementing the roles of others at regional, system, local and neighbourhood level. 

That is a big ask and they are not there yet, but they are on the journey. Following its early devolution deal, Greater Manchester (GM) has focused strongly on population health and has seen positive changes in key health outcomes for its population, with the best improvements coming from the most disadvantaged places. Population health in Greater Manchester: the journey so far gets under the skin of how GM ‘does population health’, its successes and the challenges it has faced. The key learning from GM’s journey for others is the importance of a strong and shared vision, coherent and distributed leadership, and long-term unshakeable commitment over time. Investing in capability and learning and an openness to scrutiny support this. Like others, Greater Manchester faces huge financial challenges, yet it has managed to keep to the path on population health despite this, rather than turning back.  However, to go further still it, and others, needs central government to fulfil its side of the bargain, to not only call for improvements in population health but to better enable systems to deliver them. That means funding streams and incentives, accountability and the support system all need to emphasise and reward efforts on population health, not work against them. 

The public health and population health leadership community are critical in helping to shape and implement government goals for population health on the ground. Our second report Public health and population health: leading together focuses on creating the conditions for this, showcasing good practice but not shying away from the challenges. In some cases and places population health and public health leaders are not working together as well as they need to, and we set out a number of recommendations for government, public health organisations and local systems on how to unlock the more aligned leadership needed to deliver on the 10 year plan and health mission.   

 Outward-looking and focused integrated care systems, supported by an aligned population health and public health leadership community, will therefore be best placed to make the most of the huge opportunity that lies with the government’s mission approach, beyond the 10-year health plan. This is the subject of our joint briefing Tackling health inequalities through English devolution: towards a new framework with the Centre for Local Economic Strategies.  Cities and city-regions have particularly complex and dynamic health needs and assets, and require better co-ordination of policy and funding streams to address them, as the Chief Medical Officer’s annual report this year on Health in cities makes clear.  But we know from other countries that devolution itself does not necessarily lead to health inequality reduction or population health gains. Therefore, the growth mission needs to: think beyond growth to health as an outcome from, and input into, growth; support more cohesive working between health and economic partners; and deliver fairer funding for local government. 

In conclusion, if the government’s laudable ambitions for population health are to be achieved, it needs to do as much thinking about implementation as about plans and missions. One area where the early signs on all these are good is NHS England’s ‘health and growth accelerator programme’ announced as part of the Get Britain Working White Paper. The focus is on preventing people falling involuntarily out of work by seeking to identify, prevent and manage health conditions. It will support three integrated care systems (South Yorkshire, West Yorkshire, and North East and North Cumbria) to further co-ordinate policies, activities and offers to people to support their health in work, working with combined authorities, businesses, and most importantly, people and communities themselves, while learning and evaluating over the course of the programme. The government has also announced a review of local government funding and a test and learn fund to support the national missions, and we are awaiting the devolution White Paper. These will all be critical, because local government is an essential part of integrated care systems, and the delivery of the government’s 10-year health plan and heath mission relies on a strong and capable local government sector and its contribution to population health.