Jo Underwood, a Transformation Programme Director from One Gloucestershire, discusses the integrated care system’s (ICS) work to improve health equality across the county.

Here at One Gloucestershire, achieving health equality is a not a ‘nice to do’ – it’s a ‘must do’ as a fundamental element of our ICS goal to support healthy, active communities.

Our Enabling Active Communities and Individuals (EAC-I) partnership is key to addressing the health inequalities gap – but this is not the responsibility of the group alone; health equality is embedded into all our main workstreams.

Partnership working is key to success

We’re really excited by the opportunity that working together as one ICS offers us to innovate in healthcare, developing more person and community centred approaches alongside established clinical approaches.

As health services, we cannot reduce health inequalities unless we work closely with our voluntary, community, social enterprise and faith sector partners. The key to our shared success lies in breaking down barriers and building trusting relationships between organisations and local people.

An important question for us is how we develop equal relationships between partners, making the space to explore new ideas and concepts. We’re learning more about taking a strengths-based approach, starting with the resources and assets of local people and communities and what matters to them. Healthcare traditionally approaches our health and wellbeing as a set of issues that require remedies: “What’s the matter with you?”. Working in a strengths-based way turns this on its head. We learn to start with “What’s right here, what matters to you and what can we build on?”.

Why we look beyond the provision of healthcare services in our approach

Evidence shows that socio-economic factors (housing, employment, education) have the greatest bearing on our health, followed by health behaviours (whether you smoke, are at your ideal weight, take part in regular exercise, etc.). Delivery of health services comes next, contributing around 20 per cent to our health and health outcomes, followed by environmental factors.

If we want to overcome today’s healthcare issues of growing demand, stretched resources and deep-rooted inequity, we need to look beyond our wards, clinics and surgeries for the solutions. Prevention in its broadest context is about working together on those ‘wider determinants’ (socio-economic, behavioural and environment factors) which, together, contribute to our individual and collective demand for healthcare. Ultimately what we want to prevent is avoidable illness and the burden of disease falling unfairly on certain groups more than others.

What the partnership includes

The EAC-I partnership covers a range of areas:

  • Prevention
  • We can move (a physical activity programme)
  • Weight management
  • Tobacco dependency
  • Loneliness and Social Isolation
  • Social value and community capacity building
  • Strategy for ICS/voluntary sector partnership development
  • Culture and nature in health
  • Healthier Communities Together programme
  • Gloucestershire volunteering collaborative
  • Gloucester City Health Equalities plan
  • Personalised care (a subset of the ICS personalised care programme)
  • Social prescribing (community wellbeing service commissioning and countywide social prescribing network)
  • Supported self-management techniques
  • Health coaching

Examples of the things we develop or support include a women’s exercise group in Barton and Tredworth, a ‘Breathe In, Sing Out’ programme for patients with respiratory illness, storytelling circles to help combat loneliness and isolation, and creative arts support to people discharged from Intensive Care post-COVID.
By working in a strengths-based way, we want to shift the power and control to people and communities so we create sustainable initiatives to improve health and wellbeing.

Measuring what we do and the value of improving health equality

One aim of the EAC-I programme is to strengthen local communities, and this is reflected in some of our evaluation work. By focusing on what matters to individuals and the communities they live in, and taking into account their strengths and needs, we are developing a new relationship between people, professionals and the health and care system.

This approach means that we need something more than the traditional measurements of value, as they often rely on units of care we ‘own’ such as GP attendances or hospital admissions, or indicators related to compliance, recovery or survival. When health is defined by individuals we need to understand impact on many more factors that contribute to our wellbeing: the quality of our relationships and support networks, the resources and opportunities we have to make healthy choices, and our capacity to influence the world we live in. Improving those things and measuring the value this brings to individual and collective health and wellbeing requires new approaches and certainly cannot be achieved by individual organisations working alone.

Through the we can move programme we have learnt more about taking a whole-systems approach to improving health and wellbeing: measuring value beyond provision of physical activity opportunities. We are also tracking connections and networks built through positive engagement, measuring whether we are reaching the right people (inclusion and equity), and the ‘ripple effect’ this has on empowering people to establish their own ways of being active and involved.

Growing our networks is vital. Before the pandemic, Gloucestershire County Council supported the development of Know Your Patch networks, led by voluntary and community organisations in each of our six localities. These networks aim to connect us – bringing people and organisations together to share and discover what’s going on locally and talk about issues that are important in that area. Before COVID around 800 people or organisations were registered with their local Know Your Patch network; today that number is closer to 1,800.

Moving forwards we will learn more about measuring value in terms of creating the conditions for good health: independence, skills and strengths, social connection, choice and control. In this way, health and care systems have the potential to contribute in a much more profound way to better health outcomes, and fairer distribution of good outcomes across the county.

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