Our context and case for change
Babies, children and young people comprise one quarter of our population and the GLA birth rate projections predict a significant annual increase in births in Newham and Barking and Dagenham. The population of babies born in NEL is also hugely diverse. More than one third of the population aged 0-18 is of Asian ethnicity, 14% of Black and 6% of mixed ethnic backgrounds.
In all our places except Hackney and Havering we have a higher proportion of babies born with a low birth weight than the England average. Babies born to Black and Asian women in NEL are nearly twice as likely to have a low birth weight than those born to White women. Low birth weight increases the risk of childhood mortality and developmental problems for the child and is associated with poorer health in later life.
In all our places except Havering, we have a higher percentage of children living in poverty than the England average (15.6%). There is a strong link between childhood poverty and poorer health outcomes including premature mortality. There is also evidence to show that children who live in poverty are exposed to a range of risks that can have a serious impact on their mental health.
Assessments indicate that 38,000 pupils in NEL need special educational support. 13,600 of these pupils have Educational, Health and Care Plans which outline the support they receive and these numbers are increasing.
In all places in NEL, overweight and obesity in children is higher than the England average (35%). Barking and Dagenham and Newham respectively have the highest and fifth highest rates in England. Dental decay in 5-year olds is also higher in all our places compared to England.
We saw physical and mental health outcomes deteriorate during the Covid-19 pandemic, particularly for vulnerable children and those with long term conditions within disadvantaged communities. In NEL at least 18,099 children and young people have asthma, 1,370 have epilepsy and 925 have type 1 diabetes.
We are currently seeing substantial pressures on child health urgent care services which is likely to be connected to the recent pandemic and cost of living pressures.
Currently there are 3,343 babies, children and young people in NEL with life limiting conditions requiring palliative and end of life care, and this number is gradually increasing. In years 2018 to 2020, there were around 100 infant deaths per year across NEL.
Key messages we heard through our engagement
Support for young people feels unequal, and varies depending on stage of life.
“I want to be involved in decisions about my care, and I don’t always feel that my needs are understood. The care I receive feels rushed and impersonal, and has varied in quality across services and at different stages of my life”.
What we need to do differently as a system
Create the conditions for our staff to do their best possible work including creating a safe multi-disciplinary learning environment spanning teams across NEL, provider collaboratives and place-based partnerships with a focus on co-production, quality improvement and trauma-informed care.
Focus on tackling health inequalities by working with our place-based partnerships to increase support for our most vulnerable children and their families particularly those with learning disabilities and autism, young carers, those living in poverty and insecure housing and those from a black and ethnic minority background, developing an enabling programme of work which addresses workforce challenges, supports data capture and benchmarking, and promotes better communication.
Develop clearly defined prevention priorities supporting place-based partnerships to focus on the most deprived 20% of the population and other underserved groups, as well as a focus across NEL on prevention priorities including obesity and oral health.
Develop community-based holistic care, including supporting the development of family hubs building community capacity and strengthening adolescent healthcare. Through social prescribing and multi-disciplinary teams we will enable links to community assets including the community and voluntary sector and put health inequalities at the heart of our work
Improve the experience and support available for children as they transition to adult services ensuring they receive consistent services which are designed with young people to meet their specific needs with an aspiration that young people will transition at a point that suits them and their development, rather than a rigid service threshold.
Prioritise our children and young people’s mental health, recognising the importance of support, and timely access to information, advice and care. We will harness the potential of the digital offer and work with children and young people to design and deliver high quality, accessible services in a range of settings.
Improve quality and outcomes for vulnerable babies, children and young people, including those with long term conditions, special educational needs and disabilities. Helping our babies, children and young people with asthma, diabetes and epilepsy, focussing on personalisation of care, and prevention. Supporting our children and families with special educational needs and disabilities through strengthening safeguarding, addressing workforce challenges and supporting data capture. Extending our services for autistic children and young people including the introduction of a new keyworker scheme.
What success will look like for local people
- I have the same experiences and range of support for my development, health and wellbeing, no matter where I grow up in north east London
- I have the opportunity to access healthcare, education and care in ways that suit me and my goals
- I receive high quality and timely personalised care at a place of my choice
- I am treated with kindness, compassion, respect, information and communication is accessible and understandable
- I have opportunities to share my experience and insight, and seen change that I have influenced
- I have people who treat and look after me care as I move through the different stages of my life
- I am involved in decisions about my care
What success will look like as outcomes for our population
- Reduce proportion of babies born with low birth weight in our population
- Identify children living in poverty within our communities and ensure they are receiving the support they need to live a healthy life including equitable access to and outcomes from our health and care services
- Strengthen our focus on prevention, reducing levels of childhood obesity and dental decay, and increasing uptake of childhood immunisation
- Strengthen our support for children living with long term conditions and address health inequalities by reducing the number of asthma attacks, increasing access to prevention and self-management for children and young people with diabetes (particularly those living in poverty or deprivation and those from black and ethnic minority backgrounds), increasing access to specialist epilepsy support for children, including those with learning disabilities and autism and supporting all children better through the transition to adult services
- Improve access to children and young people’s mental health services, and support young people better through the transition to adult mental health services
- Reduce the number of young people reporting that they feel lonely and isolated
- Collaborate between education, health and social care to ensure school readiness for all children and to meet the needs of children with special educational needs and disability
Our context and case for change
31% of local people have a long term condition (which is an illness that cannot be cured) such as diabetes or COPD. Living with a long term condition can impact on many aspects of a person’s life, including their family and friends and their work. People with a long term condition are more likely to suffer from further conditions or complications over time, including poor mental health.
Long terms conditions account for half of GP appointments, 70% of inpatient bed days and 70% of the acute care budget. Currently the majority of national spend on long term conditions is in acute or hospital based treatment or care with less spent in the community or in primary care. For example, for diabetes one billion pounds is spent annually in primary care nationally versus eight billion pounds in acute care.
Long term conditions cannot be cured but when identified early and managed effectively, the impact the condition has on a person and their life can often be alleviated or delayed. Some long term conditions can also be prevented completely through healthier behaviours. In the context of a growing and ageing population in NEL, we must drive a shift towards prevention and earlier intervention and ensure the sustainability of services.
People living in deprived neighbourhoods and from certain ethnic backgrounds are more likely to have a long term condition and to suffer more severe symptoms. For example, the poorest people in our communities have a 60 per cent higher prevalence of long term conditions than the wealthiest and 30 per cent higher severity of disease. People of South Asian ethnic origin are at greater risk of developing Type 2 Diabetes and cardiovascular disease, and people with an African or Caribbean family background are at greater risk of sickle cell disease.
Our population has a higher prevalence of type 2 diabetes, and several other conditions including hypertension and chronic kidney disease as well as a higher mortality rate for cardiovascular disease in the under 75s. One in five local people in NEL has respiratory disease. Further, there are likely to be high levels of unmet need – highest in our ‘underserved’ communities – that are not showing in the data but require proactive identification and better management.
Two-thirds of people with at least one long term condition have more than one mental health problem, including depression and/or anxiety, and there is a growing connection between living with a long term condition, social isolation and low self-esteem.
Key messages we heard through our engagement
Care for people with long term conditions feels uncoordinated and fragmented.
I am not always clear who I can turn to with a problem, where I can access non-medical support in my local community or support with my emotional and psychological wellbeing.
I do not want to be asked to repeat my story to different professionals and I want my transition from service to service to be much better co-ordinated and supported.
What we need to do differently as a system
Better coordination of care, including between mental and physical health and health and social care. Also better transitions between different services, such as between child to adult services, supported by information sharing which we will strive to make a practical reality for staff in their work.
More consistent communication with people living with long term conditions and their carers, including in relation to their end of life care. Ensuring that people are at the heart of every conversation and that we focus on their holistic needs and strengths (not just their care).
Empower and resource local communities and voluntary organisations to assist with case finding and linking people through to appropriate care, to increase available support for prevention and self-management, to support de-medicalising and destigmatising day to day support through social prescribing, and to increase access to emotional and psychological support and widen peer support.
Support health creation within local communities increasing opportunities and support for making healthier choices, including starting health and well-being conversations in early years and working together to reduce the number of people in NEL living with risk factors such as obesity or smoking.
More intelligent identification of those with long term conditions or risk factors using population health management data and tools to support primary prevention which includes enabling earlier and more proactive action particularly among ‘underserved’ communities where there are high levels of unmet need and greater (proportional) investment in primary care in order to lead to short-term decreases in overall health system costs.
Focusing on improving end to end pathways including improving quality of care and secondary prevention by detecting LTCs as soon as possible to halt or slow progress, encouraging personal strategies, and implementing programmes to improve health outcomes and prevent additional long-term problems.
Support people with long term conditions who may be adversely affected by poverty, particularly with the cost of prescriptions or equipment which our evidence and engagement has shown to be key issues during the cost of living crisis.
Lead by example as organisations that collectively employ a large number of people. Through our priority on workforce and local employment we will identify what more we can do as employers to encourage healthy behaviours and to support colleagues with long term conditions. We will also do more to value and support informal carers in recognition of the significant contribution they make to the health, wellbeing and independence of local people.
What success will look like for local people
- I receive the support I need to make healthier life choices, increasing my chances of a long and healthy life
- If I develop a long term condition, it will be identified early and I will be supported through diagnosis; with my individual needs taken into account
- I feel confident to manage my own condition, and there is no decision about me without me
- I am able to access timely care and support from the right people in the right place
- I feel my quality of life is better because of the care and support I received
- I am able to care for my loved one, my contribution is recognised and valued and help is there for me when I need it
What success will look like as outcomes for our population
- Reduce prevalence of obesity and we will be smokefree by 2030
- Increase earlier diagnosis including reducing the number of people with long term conditions diagnosed in an urgent care setting and increase early diagnosis of cancer
- Increase uptake of vaccines for people with chronic respiratory conditions to prevent more emergency hospital admissions
- Increase hypertension case finding in primary care to minimise the risk of heart attack and stroke within our population
- Increase the proportion of local people who say that they are able to manage their condition well
- Increase the proportion of local people who are able to work and carry out day-to-day activities whilst living with a long term condition
- Narrow the gap in outcomes for vulnerable or underserved groups e.g. people with learning disabilities and people who are homeless
- Narrow the gap in outcomes for vulnerable or underserved groups e.g. people with learning disabilities and people who are homeless
- Improve the mental health and wellbeing of people with long term conditions and their carers
Our context and case for change
Mental health affects how we think, feel and act, and has a profound impact on our day-to-day lives. It is strongly linked with wider health outcomes and therefore improvements here impact our overall ambition to improve the lives of people living in north east London.
It is estimated that at least a fifth of local people in NEL have a common mental health problem like depression or anxiety, which is higher than the England average. We are also seeing an increasing need for mental health services to support people with severe and enduring mental health problems, with some of the biggest demand pressures in children and young peoples’ mental health and eating disorder services. Equally we know that people with serious mental health problems endure worse physical health outcomes.
We have made great progress over the last several years in improving our services, with thousands more residents able to access evidence-based talking therapies, children and young peoples’ mental health services (including in schools), specialist mental health care during and after pregnancy, and crisis and community mental health services that are far more integrated with primary care.
Yet, the Covid-19 pandemic and cost of living pressures have brought new challenges and have exacerbated the inequalities that were already present in our population. We must be mindful of the need to support those with long-standing needs who may be hit hardest, while also working proactively and preventatively to mitigate the risks of ever-greater numbers of people developing mental health conditions.
We still have further to go to ensure that people of all ages with mental and physical health conditions, including carers and people with dementia, get support in the areas that matter most to them, as early as possible. However, through honest and open conversations about equity, leadership, and representation with a diverse group of partners, we are beginning to think in a profoundly different way about how we can improve the quality of life of people with mental health needs in NEL.
Key messages we heard through our engagement
What matters to me is having the same experience and range of support regardless of where I live or go to school
What matters to me is challenging stigma about mental health
What matters to me is personal development and growth
What matters to me is using my lived experience to support and help others
What matters to me is accessing support in different ways that suits me and my goals, not just what is available and not when it is too late
What we need to do differently as a system
We must ensure that service users and carers are at the heart of everything that we do and that we prioritise what matters most to service users and carers, including delivering on the priorities set for us by service users and carers:
- Putting what matters to service users and carers front and centre so that people with lived experience of mental health conditions have an improved quality of life, with joined-up support around the social determinants of health.
- Enabling and supporting lived experience leadership at every level in the system so that service users and carers are equally valued for their leadership skills and experience as clinicians, commissioners and other professionals.
- Embedding and standardising our approach to peer support across NEL so that it is valued and respected as a profession in its own right, and forms part of the multi-disciplinary team within clinical teams and services.
- Improving cultural awareness and cultural competence across NEL so that people with protected characteristics feel they are seen as individuals, and that staff are not making assumptions about them based on those characteristics.
- Providing more and better support to carers so they feel better cared for themselves, more confident and able to care for others, and are valued for the knowledge and insights they can bring.
- Improving peoples’ experience of accessing mental health services, including people’s first contact with mental health services, reducing inequality of access and improving the quality of communication and support during key points of transition.
- Understand and act upon local priorities for mental health, through data and engagement with communities to understand the needs, assets, wishes and aspirations of our borough populations, and the unmet needs and inequalities facing specific groups.
We must also ensure that mental health is everybody’s business, for both children and young people and adults, whether this is through how we work together to tackle the wider determinants of health, or how we develop more integrated approaches to assessment, treatment and support for people with or at risk of mental and physical health problems.
We must innovate to improve outcomes and access to mental health services, including in particular where there are communities that are not accessing services as we would wish.
What success will look like for local people
Our draft success factors, developed with service users and carers, include the following (more detailed statements are being finalised with children and young people and adults):
- What matters to me is having the same experience and range of support regardless of where I live or go to school
- What matters to me is challenging stigma about mental health
- What matters to me is personal development and growth
- What matters to me is using my lived experience to support and help others
- What matters to me is accessing support in different ways that suits me and my goals, not just what is available and not when it is too late.
What success will look like as outcomes for our population
- Service users and carers are active and equal partners in everything we do, across children and young people and adults
- Care professionals focus on what matters most to service users and carers, including quality of life
- Improved preventative mental health and wellbeing offer – across our populations, places and partners – with a focus on tackling the wider determinants of poor health
- Improved access to mental health services for all our communities, including community and crisis services
- Improved integration of mental and physical health care, and with schools, social care and the voluntary sector
- Improved health and life outcomes for people with, or at risk of, mental health conditions, with particular focus on where there is inequity or unwarranted variation.
Our context and case for change
North east London has almost one hundred thousand staff working in health and care, with over 4,000 in general practice, 46,000 in social care, and around 49,000 within our trusts. Our workforce is the heart of our system and plays a central role in improving population health and care. Equally we have a growing population with a high proportion of working age people – we know that work is good for health and there is an opportunity for us to improve health in our local population and contribute to the local economy by upskilling and employing more local people into health and care roles within our system.
Alongside our paid workforce, our thousands of informal carers play a pivotal role in supporting family and friends in their care, including enabling them to live independently. Analysis undertaken by Healthwatch shows inequalities of experiences for carers who have poor experiences in accessing long term conditions (51%) and mental health services (70%), between 61% and 73% did not feel involved and supported.
Our employed workforce has grown by 1,840 people in the last year. Investment in primary care workforce has seen numbers grow by 3.7% in the last year, as well as a growth in training places for GPs. Retention and growth are a key part of all our workforce plans but we still have a number of challenges to overcome. We have an annual staff turnover rate of 23% and a high number of vacancies which places an additional burden on exiting staff as well as potentially impacting access to services. We have also heard from staff that burnout has been a growing problem, particularly since the COVID-19 pandemic. The interplay of increased workload and stress due to the pandemic is still having an effect. Sickness rates for north east London were higher than the national average of 4%, at 4.9%. Although we have the second lowest sickness rate in London, we know that mental health issues are the second highest reason for sickness, behind musculoskeletal problems.
To achieve our ambitions as an integrated care system we need to ensure that our workforce has access to the right support to develop the skills they need to deliver health and care services today as well as the skills to adapt to new ways of working, and potentially new roles in the future. Our workforce is critical to transforming and delivering the new models of care we will need to meet rising demand from a population that is growing rapidly with ever more complex health and care needs.
Underpinning this we will work to strengthen the behaviours and values that support greater integration, collaboration, and trust across teams, services, organisations and sectors.
Key messages we heard through our engagement
I value flexibility and work life balance over traditional rewards such as pensions
I want career development and career growth opportunities available to me locally
I felt over-worked before the pandemic and now it’s really affecting my ability to work
I’m a local person with transferable skills but I don’t feel local health and care jobs are accessible to me
I want the informal care I provide valued and supported
What we need to do differently as a system
Work together to employ more local people contributing to the local economy by upskilling and employing local people particularly those who are unemployed or at risk of unemployment which a range of routes into jobs including apprenticeships. Also invest in growing our own workforce from within, creating a consistent pipeline in partnership with our education institutions, and utilising system-wide approaches for all sectors.
Ensure we have efficient, streamlined, and accessible recruitment processes, promoting diversity and ensuring that under-represented groups have the opportunity to be employed in our services.
Work collaboratively to develop one workforce across health and care in NEL. We will work together to develop a deal that all employers will offer that enables career pathways across sectors with a focus on flexible career development and improved access to a consistent wellbeing and training offer shared across providers.
We commit to becoming a Living Wage system adopting the London Living Wage across NEL.
Prioritise retention of our current workforce, and create the opportunities for development across organisations to ensure that we have a stable and high performing workforce in all services. We will develop system approaches to career pathways, leadership and development.
Support the health and wellbeing of our staff, with a consistent offer of support for staff which recognises the challenges brought by the Covid-19 pandemic and current cost of living crisis.
Implement and continue to develop our new ICS clinical and care professional leadership model which will increase diversity and inclusion, and support development of current and future leaders for the system working hand in hand with local people.
Develop, recognise and celebrate our social care and voluntary workforce, prioritising specific retention programmes, ensuring that they have support when needed and feel valued equally for the contribution they make.
Value the contribution of carers and provide more and better support to them so that they are able to provide better support for others as well as improve their own health and wellbeing.
What success will look like for our people
- Working in health and care in north east London, I feel valued and respected
- I have meaningful work and am able to support myself and my family financially
- I have access to training and career development opportunities whichever part of the local health and care system I am currently working within
- I feel I have local employment and volunteering opportunities across a range of health and care settings, regardless of my background
- I am able to care for my loved one, my contribution is recognised and valued, and help is there for me when I need it
What success will look like as outcomes for our people
- Increase the number of local people working in health and social care, ensuring that our workforce is representative of the community it serves at all levels.
- Increase diversity and range of professional backgrounds reflected in our clinical and care professional leadership at all levels.
- Our carers feel supported, valued and provided with the skills to deliver personalised care to meet the needs of our residents.
- Staff will be able to transfer easily between employers in health and care.
- All staff in all sectors will have access to a consistent health and well-being offer.
- As part of our employment deal, a consistent offer of development, flexibility and mobility that all organisations in north east London sign up to, including recognition of skills across sectors and professions.
- We are increasing the ethnic diversity of board level and senior leadership to reflect the make-up of the population in NEL.