As we start the financial year, we have spent a lot of time and energy focusing on our short-term financial challenges. This is clearly important, as our budget is limited and we need to do the best and most we possibly can for our population with what we have. But, this highlights just how important it is for us to keep looking forward, and focus on health promotion and prevention to stem demand and improve the health of our population, as well as our finances long term.

So, this month I’d like to share some of the work we’re doing on prevention, addressing health inequalities and using population health management (PHM) to improve outcomes in the long term.

Firstly, I’m delighted to share that our Population Health Management (PHM) strategy was published last month – please take a look here. PHM uses data-driven approaches to identify variations in healthcare access and outcomes, focusing on prevention and addressing health inequalities, to drive up quality. Here are some highlights of the work led by our PHM team over the last year:

• NHS Diabetes Prevention Programme

We identified individuals with non-diabetic hyperglycaemia, and contacted them all proactively to encourage and support them to participate in the Diabetes Prevention Programme. This led to a massive increase in programme uptake, particularly among people in previously low-referring practices and our more deprived areas. Through this initiative, an additional 1,800 people have completed the programme so far. 

• Digital Weight Management Programme

In this project, we used PHM techniques to actively identify people with obesity and preexisting hypertension or diabetes,targeting low referring practices and those living with deprivation. In June 2023, only 10% of our referral target had been met, but we are now the highest ranked ICB in the East of England with over 5,200 high risk residents referred onto the programme.

• Active NoW

This initiative aims to boost physical activity levels and so positively impact on physical and mental health. The resource is not new, but we know that it has been underused, and particularly by those amongst high-risk and deprived populations. We used PHM techniques to identify those who might benefit most, and used our virtual support team to contact and support individuals to join the scheme. Among the 4,632 participants, 72% were from the lowest quintiles of deprivation, with 69% experiencing increased activity, 79% reporting improved mental health, and 88% reporting enhanced general health after 6 months

• CVD Prevention Programme

This programme again uses PHM analysis to identify individuals at risk of cardiovascular disease before it strikes. We aim to increase the proportion of people with high blood pressure (BP) who have had a recent check, increase the proportion whose most recent BP is treated to target, increase the proportion of people with Atrial fibrillation who are taking appropriate DOACs (Direct Oral Anticoagulants) to reduce their risk of stroke, and increase the proportion of people on appropriate lipid lowering therapy. All of these interventions are proven to reduce cardiovascular disease, and so we are determined to help people reduce their risks, and in time to reduce the burden of cardiovascular conditions within our communities.

• Smoking cessation

Smoking is one of the biggest causes of health inequalities and so working with Public Health colleagues, we are also supporting a huge piece of work to try to drive this down across our communities. I’m particularly pleased that all three maternity units at the NNUH, JPUH and QEH King’s Lynn now have smoking cessation leads, all maternity staff are receiving specific training and a tobacco dependency treatment service is now in place for birthing people and their families at all of our maternity units.

• NHS Health Checks

We also work hand in hand with our public health partners at Norfolk and Suffolk county councils. Norfolk county council (NCC) has made significant progress in delivering NHS Health Checks to our eligible populations. Norfolk now ranks among the top ten performers nationally for NHS Health Checks delivery and has been highlighted in a national local government association case study. This improvement is down to the hard work of the NCC NHS Health Check improvement group and the great relationships that have been built with Primary Care and Providers.

So – please be assured that as an ICS, we are determined to seek and drive down health inequalities, and to improve the health of our population wherever we can rather than just responding to immediate needs and treating ill health.

Finance

However, as I mentioned at the start of the blog, I do think it is important that we are all aware of the financial challenges we face. Whilst as a system we have delivered a small surplus position for the end of 2023/2024 this was achieved through significant non-recurrent savings resulting in our underlying position being a significant deficit and one which will need to be addressed over the next two years to ensure we are financially sustainable.  We are about to submit the Norfolk and Waveney Integrated Care System (ICS) financial plan to NHSE for the 2024/2025 financial year. Through the incredible hard work of all of our partners, we continue to aim to submit a break-even position plan, but this is a real challenge and one that may not be ultimately achieved in final plans for all organisations within the ICS despite the ambitious and very challenging efficiency savings targets.

There has also been a change in how contracting works with the new Provider Selection Regime recently come into force, so for both those reasons, we’ve had to review all of our existing contracts even more carefully than in the past, to make absolutely sure we are getting the best value for money that we can. We have not decommissioned any services as yet, though some contracts which were due to expire have not been continued this year. 

The collaboration work on how the system can reduce the underlying financial deficit is being further developed through the newly formed Financial Recovery Board (FRB) chaired by Lesley Dwyer (CEO NNUH).  The aim of the group is to explore opportunities across the system that can reduce cost, balanced with delivering safe and effective services.  It will also explore other ideas such as how financial allocations across acute providers can be consolidated.

We have to make sure we spend what we have wisely, and we must reduce our spend to address these underlying system wide deficits working together wherever we can, while preserving quality and safety. This means that we do need to focus on stopping anything we are currently doing which is not adding sufficient value, redesigning our pathways to improve quality and deliver recurrent financial savings, and crucially we need to keep building on prevention and earlier intervention, where we know can improve outcomes and reduce demand and costs in the long term.

While we may need to make difficult decisions regarding service provision, our focus remains on delivering high-quality care that adds value to our communities across Norfolk and Waveney. We are committed to exploring innovative solutions, enhancing collaboration, and prioritising prevention and early intervention to drive long-term improvements in health outcomes.

I encourage you to share your ideas and feedback with our PMO Team as we continue our journey towards a healthier, more equitable future. Together, we can make meaningful strides in advancing healthcare equity and improving the well-being of all individuals within our communities.

Leadership Opportunities

Firstly, my wonderful deputy Dr Andy Griffiths is retiring, which means that I am recruiting! Please have a look at the job description and consider applying to become the next ICB Deputy Medical Director. It’s an exciting time to join the ICB and this job will give you a broad range of experience particularly in bringing our clinical and care professional leaders together, and in driving long term clinical transformation.

Secondly, the RCP is also running a new programme for aspiring medical directors, associate MDs, Deputy MDs and other executive roles. 

The programme has a particular focus on:

• How to have a significant impact to support the Board and Executive team
• How, as Medical Director you will play a significant role in the reconfiguration of clinical services designed to enhance patient experience, as well as provide a positive environment for colleagues
• How to work nationally, regionally, and locally to further advance Health Inequalities and champion quality of care across all clinical services.

Please contact Legget-Jones (Assistant Director for Medical Education at the RCP Janet.Legget-Jones@rcp.ac.uk) if you have any queries.

Schwartz Rounds

Finally, the dates for our next round of system wide Schwartz rounds have just been finalised – please click on the links below for more information or to book onto a round:

With thanks as ever, for all that you continue to do.

Frankie