Suffolk & North East Essex Integrated Care System

Our primary ambition: Reducing health inequalities

Achieving this Higher Ambition will mean that:

Everyone in Suffolk and North East Essex has the same life expectancy no matter their circumstances or where they live.

As an Integrated Care System we will ensure that:

  • Everyone has their basic needs met
  • People have local, well paid, sustainable jobs
  • Everyone has equal access to health and care services regardless of their circumstances or level of deprivation
  • Carers do not experience deprivation
  • Children and young people at risk of being looked after, and those in and leaving care, have the right support for their health and care needs

What’s the current picture?

The current significant difference in life expectancy between those living in the most and least deprived areas of Suffolk and North East Essex would be reduced.

Life expectancy at birth represents the cumulative effect of the prevalence of risk factors, prevalence and severity of disease, and the effectiveness of interventions and treatment.

CVST runs a lunch club which has been described as a life line, particularly during the cold winter months. It is specifically catered for those who are isolated, vulnerable or living in poor housing and sometimes hosts those who are homeless. Last winter, a man came into the Lunch Club just as it was closing and he was initially reticent. But during conversation, he told staff he was cold, that he hadn’t eaten, he had been homeless for a while and had been moving from place to place. The cook provided a hot meal and sat and chatted to him. He apologised that he didn’t have any money, that he had many issues and was struggling to claim benefits. The cook advised the man not to worry, that CVST has members of the team who could help him and on his return to the lunch club, staff assisted with his benefits claim form and gave him advice and guidance. He was also encouraged to return to the lunch club to help out and to also try out the friendship café. The man was eventually housed, he was still on avery low income but contributed small amounts each time towards his meals.

The man returned with his daughter who had been sent down from London by his ex-wife and said he was struggling to feed them both, however, the cook supplied a hot meal for both father and daughter. The overall impact of the support given is that the man is enjoying improved health and improved mental health; he has a better relationship with his daughter, he has made friends battending the lunch club regularly and has accessed other community activities.

What do we know about people’s local experience?

  • Young people in deprived areas feel that they are not heard or taken seriously and are not involved in the planning of their care. They feel victimised by the services intended to protect them, and in turn disengage with these services to the detriment of their health and wellbeing.
  • These young people often feel let down by the difficulty in making health appointments, a high turnover of social workers, and the closure of support services.
  • Young people want information to make informed decisions before they adopt behaviours from peers or family that are hard to break.
  • Families in poverty want better information sharing between mental health workers and family support practitioners.
  • There is a lack of joined up working between education, social care, mental health, youth offending, safeguarding, health and employment services.
  • Families living in deprived areas want professionals to signpost them to support services.

Healthwatch Essex and Suffolk

It is essential then as an ICS, if we are to optimally impact on these areas that we use the widest range of NHS and partner opportunities available to us to tackle these issues. This is important in Suffolk and North East Essex as economic growth in many areas has been poor with increasing levels of relative and absolute deprivation. This leads to increases in all physical and mental health conditions and on demands for health and social care services including children’s social care needs.

The key driver of health is material wealth and the key driver of this is educational attainment. These are areas in which Suffolk and North East Essex performs inconsistently and poorly. The best efforts of the NHS will never reverse this in its traditional role.

Tendring will be a particular area for focus. The area saw the third biggest national decline in the Index of Multiple Deprivation between 2010 and 2015 and
includes the coastal communities of Clacton and Harwich. It also includes a number of rural villages that fare relatively well and somewhat mask the true decline in areas such as Clacton. Clacton is one of the most deprived communities in the country. Other areas also feature significant deprivations including parts of Ipswich and rural areas in Suffolk.

The ICS offers an opportunity for us to work as a system to mobilise all our resource to tackle this issue. There is a long history of targeted services in health, public health, district, county and third sector to address downstream impacts of the increasing deprivation and these must continue and indeed increase. More importantly we need to work as a system to start to tackle the upstream issues around education and economic growth. It is only through work in these areas that we will see a reversal in health outcomes.

Primary Ambition
  • People living in poorer areas not only die sooner, but spend more of their lives with disability.
  • The social gradient of health inequalities - the lower one’s social and economic status, the poorer one’s health is likely to be.
  • Health inequalities arise from a complex interaction of many factors - housing, income, education, social isolation, disability - all of which are strongly affected by one’s economic and social status.
  • Health inequalities are largely preventable. Not only is there a strong social justice case for addressing health inequalities, there is also a pressing economic case. Deprivation costs society billions through lost taxes, welfare payments and costs to health and care services.
  • Action on health inequalities requires action across all the social determinants of health, including education, occupation, income, home and community.

The ICS includes a range of key organisations that will act as key anchor institutions across Suffolk and North East Essex and will use this position to support areas of deprivation including Clacton and Harwich in particular but also deprived areas of Ipswich and rural Suffolk:

  • The ICS will recognise its overarching role in improving health and wellbeing and will frame this against agreed need to jointly tackle the declining outcomes with respect to healthy life expectancy.
  • ICS partners will be more explicitly recognised as a key part of the community rather than just a provider or services.
  • Local business will benefit as part of a recast supply chain and will in turn be encouraged to support local growth.
  • Most ambitiously, the ICS will use its national profile to highlight to government the value of moving a department locally both for the government and for the local population.
  • Additionally, Primary Care Networks (PCNs) will be appropriately resourced according to population need with appropriately more capacity in areas of high need to both deal with expressed need and the ability to develop local bespoke solutions to start to surface unmet and unexpressed needs.
  • Key players will be ICS partners as major employers and buyers. This will include NH bodies, County Councils, Districts and Boroughs, Office of Police, Crime and Fire Commissioner, Universities, and Further Education colleges.
  • It will also involve particularly local secondary schools and their links to ICS anchors. I will involve local businesses through the Chamber of Commerce and Federation of Small Businesses. Ideally it will involve external government department who would relocate. It would involve local Job centre Plus.
  • There is a key role locally for the voluntary sector in supporting particularly excluded groups.
  • Clinical colleagues will recognise the importance of wider determinates. This will include supporting people with mental health issues around work and needs to involve mental health providers and primary care. Additionally clinical services will need to ensure people in contact with them who may be in poverty have full access to benefits they are entitled to. This would involve links with social prescribers within PCNs. There will also be links between health visitors and Citizens Advice Bureau to improve access to benefits to families based loosely on the Healthier Wealthier Child model.
  • Reduced gap in Inequality in Life Expectancy at birth (male)
  • Reduced gap in Inequality in Life Expectancy at Birth (female)
  • Less Statutory Homelessness
  • Fewer people living in Fuel Poverty
  • Lower rates of Violent crime
  • Fewer children under 16 in Low income families
  • Fewer 16-17 year olds Not in Education, Training or Employment
  • Fewer Children aged 10-14 in the youth justice system
  • More adults with qualifications that will help them into work NVQ level qualifications (adults 16-64)
  • More adults with qualifications that will help them into work NVQ level qualifications (adults 16-64)
  • Increased uptake of Free School Meals among all eligible pupils
  • More employment among people with Mental Illness or Learning disability
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Suffolk & North East Essex Integrated Care System
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