49 Suffolk and North East Essex ICS | ‘Our Journey Together’ 6. Our Legacy 6.1 The Road Ahead Context Around 80% of our health outcomes are shaped by factors beyond the reach of healthcare services. To genuinely improve population health, we must collaborate meaningfully with the organisations best placed to influence these wider determinants—most of which sit outside traditional healthcare commissioning. Without this shift, it will be impossible to make substantial progress on improving health outcomes or reducing health inequalities. Public services—including health, local government and wider public sector bodies—are now undergoing a fundamental transformation that will continue over the next few years. This presents a “once in a generation” opportunity. To grasp it, key organisations must look ‘up and out’ rather than ‘looking down and in’ – they must work collectively rather than focusing solely on internal priorities. Only by doing so can the public sector maximise its collective ability to influence health and reduce inequalities. The next two years, before devolution arrangements and local government reorganisation take effect, offer a crucial window. If we use this period to strengthen relationships, agree shared priorities and plan for deeper integration, we can position ourselves for meaningful impact. Those who embrace this opportunity will be far better placed to improve health outcomes than those who do not. Strategic Combined Authorities Strategic Combined Authorities (SCAs) will be established over the next two years. They bring together multiple uppertier councils and will lead to the abolition of current County Councils. SCAs are responsible for large-scale, high-impact areas—including economic growth, transport, skills and employment, public safety and spatial planning—all of which directly influence health and health inequalities. Most Strategic Combined Authorities include an elected mayor, and this is the planned model for Essex, Norfolk and Suffolk, with mayoral elections expected in 2028. Under the forthcoming Devolution and Community Empowerment Actxxiii, the mayor will have a duty to consider health outcomes and health inequalities across all areas of SCA responsibility. The Act, currently progressing through Parliament, will give mayors the powers needed to address key determinants of health and to convene stakeholders when necessary. The mayor is expected to be required to consider “the need to improve health and reduce health inequalities” for local residents. This includes outcomes such as life expectancy and the general health of the population. The mayor and Strategic Combined Authority cannot achieve this alone; it will require close collaboration with Unitary Authorities, health commissioners and providers. The mayor is also expected to sit on—or be represented on—the NHS ICB Board, providing a direct route to influence health commissioning and advocate for their population. The role of the Strategic Combined Authority in facilitating collaboration and shaping local priorities on the wider determinants of health is significant and should not be underestimated. Strategic Combined Authorities will also have a strong voice nationally, influencing central government policy on health and inequalities. Evidence from Greater Manchester and Greater London shows how devolved arrangements can drive positive change.
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