Kieron Boyle, Chief Executive, Guy's and St Thomas' Charity
Feb 26, 2019
This week I’m joining an expert panel at the annual Nuffield Trust Health Policy Summit, where policy-makers and practitioners will be discussing pressing issues for the NHS and national health. It’s an opportunity for us to learn and share insights from our work in inner-city London.
Our focus is on complex health issues that are nationally relevant and locally prevalent. The issues tend to be heavily influenced by people’s environments, have a steep income gradient, and often have much worse health outcomes for people from BAME communities.
Multiple long-term conditions is a fascinating topic in many regards – not least because over 8 million people in England live with three or more health conditions. Yet, the whole issue seems to be hiding in plain sight. While people increasingly talk about the complexity in their lives caused by their multiple conditions, the NHS Long Term Plan gives it only a handful of mentions.
Our ten year programme combines research, community engagement and testing practical ideas. It’s a combination of local and national perspective which we think gives interesting insights relevant to other urban areas.
Like many others, we’re only just beginning to understand the full depth of this issue, but here are five emerging lessons:
At least a third of people living with multiple long-term conditions in our boroughs are middle aged or younger. This means it’s as much a challenge for employers and society as it is for the health and care system. We’re focusing on working age people who already have one condition, looking to slow down their journey from one to many.
The most frequent route to identifying people with multiple long-term conditions is through GP Practice registers. In urban areas like ours this captures a lot of people but misses others. We‘re finding that it’s important to invest in new ways to identify people at risk – for example, through commercial, housing and community partners – so we can have a much more accurate picture of where to target efforts.
Many things – income, background, housing, employment, relationships, location – define a person’s experience of long-term conditions. For example, although black communities make up 18% of our local adult population, they account for 27% of those with multiple long-term conditions. We’re focusing on areas like Peckham where there is a large black population and many people living with diabetes, the most common condition on the journey from one to many.
Our work on the ground is showing us that the answers aren’t just medical. They must also encompass social factors, like employment, housing and finances, as well as community ones, like developing more resilient neighbourhoods. Like many others, we’re engaging in social prescribing, but also looking to go further – for example, exploring models like participatory funding, where local residents have more say about what we fund.
We’re finding that complex issues like this are daunting but we’re also optimistic that progress is possible. For our part, we’re taking a structured approach to building wide partnerships – with businesses, local authorities, the NHS, charities and community groups – and working at different geographic levels. Some work is hyper local, partnering with anchor organisations like Pembroke House who are already well connected with their neighbourhoods. Other work is cross-borough, such as supporting Local Care Networks to test new ways of working. And some is national – for example, helping establish the Taskforce on Multiple Conditions to influence national policy in ways that benefit our residents here in Lambeth and Southwark.
Over time, we’ll continue to build and share our understanding about multiple long-term conditions and what this means for improving health in urban areas. If you’d like to hear about either, do please sign up to receive our newsletter.