Partner and Head of Local Government at Grant Thornton UK LLP
Can analysis of health determinants in each local authority, and collaborative management of their outcomes, pull our public services together?
It has long been recognised that the health of a population is strongly linked to the circumstances in which people live. Our new research - Growing healthy communities: The Health and Wellbeing Index - clearly supports this assertion, and highlights the extent to which key health determinants translate to good or bad health outcomes in their broadest sense. It also shows the scale and nature of inequality across the country and reiterates the need for a local, place-based approach to tackling health outcomes.
Our research, based on league tables that assess 33 key health determinants and outcomes for the 324 local authorities in England, provides a coherent national story on health and wellbeing. The factors that influence public health are extremely varied and in order to try and meet the required cuts local authorities need to recognise what areas directly influence well-being and be proactive in tackling them.
Health determinants are those factors identified as having a key influence on an individual's prospects for good health. Some examples include unemployment, child poverty and social housing. These can be broken down into three key areas: economic, social and environmental.
Health outcomes can be split into two categories: healthy lifestyles, measured by examples such as adult and child obesity, and health conditions, measured by factors such as life expectancy and infant mortality rates.
Our analysis reveals the top three determinants that most strongly correlate to health outcomes are child poverty, deprivation and unemployment. Surprisingly, crime ranks as only the seventh strongest factor with childhood education, social cohesion and occupations all proven as having a bigger impact on overall health outcomes.
The research shows a clear North-South divide in both health outcomes and determinants. The South East ranks highly in determinant scores, with eleven south east local authority areas featuring in the top twenty. The region also achieves some of the best health outcomes overall, along with parts of the South West and East of England.
Conversely, despite having only two local authorities in the twenty lowest-ranking authorities in terms of health determinants, the North West has a number of poor health outcomes. Eleven of the twenty lowest-ranking local authorities in this area.
We also found that neighbouring authorities can have completely different determinant and outcome results, with poor performing areas situated right next to those with more favourable indicators. Nottingham City and Rushcliffe is a good example of this. Local authorities, CCG's, and health and wellbeing boards need to investigate why these differences are occurring in order to address the needs of their population,.
We designed the report to promote collaboration between local authority stakeholders by increasing their understanding of the correlation between the key determinants and health outcomes within their locality. The regional segmentation of the report allows us to highlight the huge scale of inequality across England and promote the need for areas to work collaboratively and learn from 'others like us'.
Although the data shows a high correlation between determinant and outcome scores, the research also highlights a number of areas where 'over-performing' authorities are achieving better health outcomes than their health determinant score would predict. All but one of the top ten 'over-performing' areas are in London. The remaining outlier is Babergh in Suffolk.
Barnet council is ranked as the fifth best 'over achiever' in terms of health outcomes outperforming determinants. The council and CCG work closely with both Haringey and Enfield councils and CCGs, and have collectively implemented a number of initiatives to tackle their determinants.
Together they have introduced the 'Choose Well' campaign, which aims to provide people with information on how to choose the right NHS service, in order to reduce pressures on health services. Their joint aim is to reorganise healthcare services to deliver modern standards of clinical care to patients. This has included restructuring facilities at Barnet, North Middlesex, and Chase Farm hospitals.
While we can see that determinants heavily influence a location's outcomes, this research has also shown how it is possible for determinants to be influenced and outcomes improved by collaboration between local partners. There is no better time than now for our public services to pull together.
The public sector's structure is strong thanks to the introduction of the Health and Social Care Act 2014, Better Care Fund, NHS Five Year Forward View and the developing devolution agenda. We believe that significant results could be achieved if Whitehall promoted place-based approaches.
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