15 Suffolk and North East Essex ICS | ‘Our Journey Together’ 3. Our actions and their impact What we did together and how it made a difference 3.1 Contribution vs Attribution Stakeholders described a very wide variety of stories and examples of where they felt that Suffolk and North East ICS had enabled an impact that has contributed towards improved health outcomes for local people and communities. It is important to highlight that the issue of measurement of the impact of the ICS on outcomes is difficult. The complexity of health and wellbeing means that no single organisation can alone deliver the positive health and wellbeing outcomes our population needs. The health outcomes that matter to the people we serve require multiple agencies each to play their part in doing the right things and doing them well. It is the combination of these that make the difference. Changing health outcomes therefore requires a holistic approach, fostering partnership and recognising shared responsibility. It is impossible to single out direct causal relationships between an action and a result in a complex system, but we can identify how each partner contributes to that result. Attribution means proving "what happened" due to one causal factor, while contribution is about "why it mattered" within a larger context of all the factors that influence health and wellbeing. Adding to that complexity is that the wider determinants of health, the socio-economic and environmental, national and even global factors which have the most significant effect on health outcomes, are beyond the sphere of control of health and care services. That creates even more difficulty in measuring our impact, and the numerical metrics that often accompany simple cause and effect measures are not sufficient to reflect the full range of variables and influences on people’s health and wellbeing. It is therefore impossible to attribute any measurable change in population health and wellbeing outcomes solely to the health and care partners working together in the ICS. There are many areas where we can see evidence-based actions that, alongside other things, are achieving measurable benefits that contribute to improved health outcomes for our populations. And where benefits have been delivered these are most likely to be the result of multiple actions at different times and by different stakeholders working together in new ways. Based on what we heard from stakeholders, we have identified five action areas that have contributed to the delivery of benefits for the population that will in turn contribute to improved population health and wellbeing outcomes. These areas are: • We brought people and organisations together in new ways • We shared our resources and data • We enabled new investment into the system • We heard the voices of everyone in the system • We focused on improving population health and wellbeing outcomes. For each action area we have provided a high-level description of just a few examples of the myriad collaborative achievements across Suffolk and North East Essex ICS over the last decade. Further examples and case studies are available on the Suffolk and North East Essex ICS website and in communications by individual partner organisations in the ICS. Find out more about our case studies at www.sneeics.org.uk/learningandlegacy
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