There are many different aspects systems had to incorporate into their strategies and JFPs such as ensuring the needs of underserved populations were identified; using a ‘life course approach’ and including measures to improve health and wellbeing outcomes and address the wider determinants of health.
How are ICS strategies and Joint Forward Plans addressing health and healthcare inequalities?
Aim of the report
In 2023, 42 Integrated Care Systems (ICS) published their first Integrated Care Strategies and Joint Forward Plans (JFPs). The purpose of the JFPs was to outline how they intend to exercise their functions over the next five years. The Department of Health and Social Care and NHS England, respectively, developed guidance to support the implementation of these documents.
We were commissioned by the Healthcare Inequalities Improvement Team at NHS England to explore the content of ICS strategies and JFPs to gain insight into how they address health and healthcare inequalities. We undertook a baseline audit of all 42 system strategies, JFPs, and any associated health inequalities strategic plans.
To ensure a comprehensive review, we followed a structured approach consisting of distinct phases of activity.
- Sourced all 42 strategies, JFPs, and any specific ICS health inequalities plans documents through online searches, reviewing board papers, and contacting systems directly.
- Developed a data extraction tool that was used to frame the information-gathering process and guide reviewers in reading the documents. The tool included a broad range of topic areas which were refocussed as the development and testing of the tool was undertaken.
- We reviewed and analysed 88 documents in total which equates to 2,800 pages.
- Thematic analysis was performed, and a write-up of the findings was produced.
This work was done in collaboration with the Solutions for Public Health (hosted by AGEM CSU) who acted as independent quality assurance advisors and provided input into the design of the review methodology and testing phases.
Key findings
- Systems have set overarching vision statements centred on local population and communities achieving healthier and longer lives.
- Systems have often taken life course approaches and adopted conceptual models to develop their visions and priorities for their strategies and plans.
- Systems have used the Wider Determinants of Health to frame their strategies and interventions. The main determinants of health are recognised as income, housing, education, employment, and environment. Systems are using their Anchor Institutions status and social value capability to build on this.
Additional insights
Synergy between strategies and JFP
It is well recognised that strategies and JFPs have different purposes, however, the reviewers found the synergy between the two documents for a large proportion of the systems was weak. The features and themes in the strategies were sometimes not reflected in the JFPs which meant that there were often inconsistencies, especially with regards to outcomes.
Trauma-informed approaches
Nineteen systems have set ambitions to become a trauma-informed or response system. The UK Government has established a working definition of trauma-informed practice and six principles that underpin this. Many have set commitments to adopt these principles and roll out trauma-informed training, services, and care pathways.
Increased use of Health Equity Assessment Tool (HEAT) and Equalities Impact Assessments (EHIA)
Many systems are utilising the HEAT and EHIA tools to monitor the impacts of all forms of inequity and demonstrate assurance to system.
System challenges and risks
The main challenges and risks described by the systems are financially focused. Due to the current financial challenges systems are facing they are unable to secure recurrent funding and upscale preventative upstream interventions such as alcohol harm reduction interventions and weight management.
Conclusion
A strong focus on health and healthcare inequalities in ICS Strategies and JFPs represents a significant step-change in how health and care systems are tackling this key population health priority post-Covid. They signal a level of commitment and determination not strongly in evidence in the period from 2013 to 2020.
Systems are using partnerships, community assets and evidence-based interventions to maximise impact and reduce the gap in inequalities.
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