Infrastructure is defined as the individuals, facilities, and buildings required to deliver world-class care. A NEL Infrastructure Plan spanning the NHS, social care, and public health is required to ensure our staff have access to high quality facilities and can utilise growing technologies such as genomics and Artificial Intelligence (AI), to deliver better care and empower local people to manage their own health. This will be increasingly important in the context of demand that is set to increase significantly from already challenging levels due to NEL’s unprecedented population growth, and ageing population with more complex health needs.
Physical infrastructure
Decades of austerity has led to funding not keeping pace with rising demand in both building capacity and essential maintenance. This coupled with a fragmented national approach to funding NHS buildings and infrastructure has led to capacity constraints across our system and a backlog maintenance adjusted sum of over c.£650 million. This is over 7 times higher than NEL’s annual capital departmental expenditure limit or ‘CDEL’ which was £84m in 2022. In future we will develop a new, strategic approach to planning and improving our physical infrastructure by creating long-term assets that support the delivery of world-class care, promote quicker recovery and better enable staff to care for patients using the latest equipment and technology.
As part of this we are planning significant investment in our critical infrastructure including a full redevelopment of the Whipps Cross hospital site and a new £40m integrated health and wellbeing hub planned at St George’s in Havering, bringing health and care partners across the borough together to deliver a new integrated model of patient focused care, opening in 2024. We are working closely with local authority partners to ensure health and care investment and capacity is present in all new regeneration areas to enhance and increase capacity in front line care for new and existing local people.
Digital infrastructure and innovation
As technology continues to develop, digital transformation will enable people to improve and manage their own health, tackling rising demand, integrating services, empowering our staff and lessening the impact of these services on the environment. Our work will focus on connecting systems together, minimising the number of different systems in use and utilising the huge amount of data available to improve care at a personal and population level.
We will build on the existing London Care Records programme to connect patient records in real-time across providers to support direct care. This will mean that health and care professionals can access information from general practice, acute hospitals, mental health providers and social care in order to provide the best, personalised support for an individual. By fully implementing London Care Records across all partners we will deliver improved, joined up and better care for local people by enabling quicker and safer decisions. We will ensure that appropriate data held by NHS organisations and our local authority partners can be shared and linked to support better health and care outcomes for our local population. We will enable local people to have access to their records and to access remote care and advice. In future local people will need to tell their story only once across their health and care journey because all practitioners will have access to the same information.
Digital exclusion
Reducing digital exclusion is an essential component of our work to ensure we do not exacerbate health inequalities as we extend the range of services available digitally. We will reduce the number of local people and staff who experience digital exclusion by improving digital skills, connectivity and accessibility across our population as well as ensuring that alternative, in person, options are available for those who do not use digital services. We will monitor the access, experience and outcomes of different groups to digital and alternative service offers to ensure equity or access, experience and outcomes
As a health and care system we spend over £4bn every year on our population. We must ensure that money is spent as effectively as possible to meet the needs of our communities. We have a growing and ageing population which, over time, will have different needs to the people we serve today. This means that we will need to resource existing care services which are currently facing challenges in relation to demand, as well as investing in adapting our services for future needs and increasing our investment in prevention.
Collective stewardship
To meet the needs of our partnership, we are changing how money flows around the system. We are giving our partners a much greater say in how money is spent and are working together to consider the health and wellbeing of local people holistically. That means partners (such as trusts, primary care networks and local authorities) are taking collective stewardship of the money we are spending on our population and considering what we could change to improve population health and care outcomes. Reducing inequalities in the health and care outcomes of local people is a priority for the system and our financial regime will support this by targeting additional funding towards those areas and populations with the worst outcomes, and ensuring that all local people can access core services, whichever part of north east London they live in. We will also build on current arrangements for pooling resources between partners (under section 75 arrangements), and look to expand these to cover the full set of local and system outcomes, including wider partners and enabling more integrated care.
Investing in prevention and innovation
We will increase, over time, the proportion of our budget that is spent on prevention (both primary and secondary) and earlier intervention, to ensure local people are kept healthier for longer and, in turn, reducing the need for more specialist services. To support the transformation of health and care services, we will set aside some of the funding we receive to specifically fund improvements that support sustainability, such as technology which improves health and care outcomes for our population. Alongside this, we will improve our use of evaluation, to build our understanding of how money is spent and what outcomes we are achieving for our people and communities. We will use our shared data to develop the evidence base in support of continuously improving delivery and outcomes.
Improving sustainability of our system and core services
Over half of our health and care budget (or approximately £2.6bn) is spent on secondary care provided by our trusts. We will continue to look for productivity improvements – in particular within our trusts – to ensure that we are maximising value for money, including reducing waste and avoidable spend, such as over-reliance on agency staff. The pandemic, cost of living pressures and rising inflation have added to system pressures and left us financially and operationally challenged as a system. Our trusts, with their substantial cost bases reflecting their large estates and workforces, have borne much of the financial pressure. We will continue to support the financial sustainability of our trusts and also the sustainability of the key services they deliver with a current focus on urgent and emergency care, and addressing waiting times and equity of access for planned care. Actions we will take to reduce avoidable demand for acute services include supporting greater streamlining and harmonisation of services and developing more comprehensive multidisciplinary provision in neighbourhoods. This work is already underway as part of the our implementation of the recent Fuller Review recommendations.
In addition to our focus on tackling health inequalities as described above, we are working to tackle unwarranted variation, ensuring that equity is embedded across all of our strategies, plans and ways of working.
Equitable core service offer for NEL – we commit to developing and implementing a core set of services (particularly across community and mental health services) in NEL as well as addressing variation in local policies to ensure consistency and equity across our geography.
Place based partnerships and provider collaboratives – will increase their detailed understanding of equity and unwarranted variation in relation to health and care services, improving equity of access, experience and outcomes for underserved groups working hand-in-hand with local people and communities. Central to our ambition is our continued commitment to the development of an effective voluntary, community and social enterprise alliance which will ensure that the sector is fully embedded in our ICS, on an equal footing with other provider collaboratives.
Anchor institutions – we will address the wider determinants of health and reduce health inequalities, through providing employment for local people who are furthest from the labour market, increasing social value in procurement practices, and tackling climate action for a greener, healthier future.
Data and digital – we will strengthen our understanding and focus on population health and inequalities at a granular level for different population groups and especially for underserved people and communities, including through development of Population Health Management across the system.
Investment – we are establishing an equitable funding framework to allocate resources in ways that do not exacerbate but reduce health inequalities. Resources enable a baseline of consistent provision to support equity in outcomes, whilst at the same time being proportionate to need across groups and places.
Workforce – we will support inclusion within our current staff and take action to develop a workforce that is reflective of the local community. This includes improving equity in recruitment, development, management and disciplinary processes, more diverse boards and senior management teams, and championing anti-racism across all parts of the system.
Safeguarding the welfare of children, young people and adults across our system – all staff working in our system have a responsibility to ensure their practice is robust and complies with statutory requirements. We will ensure all of our services are focused on delivering safe, good quality and effective care including for the most vulnerable in our population.
Quality improvement, safety and transformation – we will equip all staff (clinical / care professional and managerial) working on quality improvement (QI), patient safety, safeguarding and transformation with an understanding of health inequalities and equity through training, fellowships and shared learning. Rapidly scaling what works across the system.
Evaluating our impact – we will set out a requirement for evaluation of the health inequalities impacts of any changes through the use of the Equality impact assessment process, developing understanding of how equity considerations can be continually built into service design and improvement.
In addition to our focus on tackling health inequalities as described above, we are working to tackle unwarranted variation, ensuring that equity is embedded across all of our strategies, plans and ways of working.
Equitable core service offer for NEL – we commit to developing and implementing a core set of services (particularly across community and mental health services) in NEL as well as addressing variation in local policies to ensure consistency and equity across our geography.
Place based partnerships and provider collaboratives – will increase their detailed understanding of equity and unwarranted variation in relation to health and care services, improving equity of access, experience and outcomes for underserved groups working hand-in-hand with local people and communities. Central to our ambition is our continued commitment to the development of an effective voluntary, community and social enterprise alliance which will ensure that the sector is fully embedded in our ICS, on an equal footing with other provider collaboratives.
Anchor institutions – we will address the wider determinants of health and reduce health inequalities, through providing employment for local people who are furthest from the labour market, increasing social value in procurement practices, and tackling climate action for a greener, healthier future.
Data and digital – we will strengthen our understanding and focus on population health and inequalities at a granular level for different population groups and especially for underserved people and communities, including through development of Population Health Management across the system.
Investment – we are establishing an equitable funding framework to allocate resources in ways that do not exacerbate but reduce health inequalities. Resources enable a baseline of consistent provision to support equity in outcomes, whilst at the same time being proportionate to need across groups and places.
Workforce – we will support inclusion within our current staff and take action to develop a workforce that is reflective of the local community. This includes improving equity in recruitment, development, management and disciplinary processes, more diverse boards and senior management teams, and championing anti-racism across all parts of the system.
Safeguarding the welfare of children, young people and adults across our system – all staff working in our system have a responsibility to ensure their practice is robust and complies with statutory requirements. We will ensure all of our services are focused on delivering safe, good quality and effective care including for the most vulnerable in our population.
Quality improvement, safety and transformation – we will equip all staff (clinical / care professional and managerial) working on quality improvement (QI), patient safety, safeguarding and transformation with an understanding of health inequalities and equity through training, fellowships and shared learning. Rapidly scaling what works across the system.
Evaluating our impact – we will set out a requirement for evaluation of the health inequalities impacts of any changes through the use of the Equality impact assessment process, developing understanding of how equity considerations can be continually built into service design and improvement.
The three core elements of our interim strategy set a clear direction for the system ahead of the 23/24 planning round, and looking to the future will be the basis for our longer term planning as a system…
……Our 6 crosscutting themes underpinning our new approach as an ICS
……Our four system priorities for improving quality and outcomes, and tackling health inequalities
……Our key areas for securing the foundations of our system
As well as influencing the annual planning round for the NHS, the integrated care strategy is the ‘umbrella’ for the full range of strategies and plans across the partnership including local joint health and wellbeing plans, plans developed by provider collaboratives, and other system wide plans e.g. relating to people, sustainability, quality and finance.
In line with our learning system approach and partnership ethos, we are committed to continued dialogue with all parts of the system to support ongoing alignment.
While the strategy has been informed by existing insights via Healthwatch as well as feedback from local people and service users in some areas, the key messages, priorities and success measures will be tested further with local people through a ‘Big Conversation’ planned to take place in Spring 2023.
We will review our interim strategy in line with further guidance anticipated from the Department of Health and Social Care in June 2023.
We will also develop the success measures outlined in the strategy further to enable the partnership to track progress over time, ensuring we are making a measurable difference with and for the people of north east London.
NEL Provider Collaboratives
- Community collaborative – The Community Health Collaborative brings together NHS Community Health Services to focus on population health needs that are best supported at an ICS or multi-borough level including working with local authority partners to achieve common standards and outcomes, reduce unwarranted variations, address inequalities in health outcomes, and improve access and experience of services.
- Mental health, learning disability and autism collaborative – In North East London, the Integrated Care Board, East London NHS Foundation Trust (ELFT) and North East London NHS Foundation Trust (NELFT) have come together to form the Mental Health, Learning Disability and Autism Collaborative. Our aim is to work together to improve outcomes, quality, value and equity for people with, or at risk of, mental health problems, learning disabilities and autism in North East London.
- Primary care collaborative –
- This brings strategic primary care leadership together and will work at scale to agree the priorities that best support and improve primary care across North East London. Key programmes of work will include the delivery of the ICB strategy and the implementation of the Fuller review programme across North East London and will involve close working across the whole system with partners in place based partnerships and provider collaborative.
- Voluntary, community and social enterprise (VCSE) alliance – The VCSE alliance brings specialist expertise and fresh perspectives to public service delivery, and is particularly well placed to support people with complex and multiple needs and finding creative ways to improve outcomes for groups with the poorest health.
- Acute provider collaborative – Our acute provider collaborative is comprised of the three acute trusts across NEL. The organisations have agreed to work together across six clinical pathways (planned care, critical care, maternity, urgent and emergency care, cancer, and babies, children and young people) and three cross-cutting strategic themes (clinical strategy, research and specialised services).