The Norfolk and Waveney Integrated Care System launched in July 2022 bringing together local authority, NHS and wider partners to improve health and care outcomes, with its priorities including driving integration, addressing inequalities, prioritising prevention and enabling resilient communities. 

In addition to the ICS, health and wellbeing partnerships were launched to work at a place level with a prevention led focus on improving health. 

James has led Breckland's work with its Health and Wellbeing Partnership Board and ICS for the past two years. 

‘The ICS really has helped deliver a partnership approach to healthcare,' he said. ‘It's still developing. It's not the finished article but it's a work in progress.'

The executive director said the ICS had brought the district council closer together with the NHS. 

‘It has helped us understand some of the challenges that colleagues in the health system face but equally it has helped those colleagues understand the really important role that district councils play in the health and wellbeing of residents especially around some of those wider determinants that district councils have a real influence over,' he said.  

Deprivation and health inequalities are a significant issue with parts of Breckland within the 20% most deprived areas in the country. 

Historic problems with poor mental health, cardiovascular disease and alcohol consumption were exacerbated by the Covid pandemic resulting in a need for greater concerted action. 

‘We know people in Breckland are more likely to be affected by mental health issues and we want to do some work that addresses that,' James said. ‘We know in some places cardiovascular disease is above average in England. We also know that in those wider determinants of health there are pockets in Breckland of a low-wage economy and we know that health and wealth are interlinked and therefore we look to address that through our economic development work.'

Tackling health inequalities 

James highlighted the council's flagship community health and wellbeing worker project as a successful example of how it has worked with partners to tackle health inequalities. Inspired by a concept in Brazil, the project has involved appointing and training two community health and wellbeing workers to go into deprived communities and facilitate better engagement with healthcare services. 

The community workers are employed by the district council but clinically supervised by the GP surgery. They also have full access to shared council and GP systems data. James said the project had registered a number of ‘incredible' successes, including record delivery of community vaccinations, helping people return to work, creating new online access points for non-English speakers and preventing three people from taking their own lives. 

The council also delivers social prescribing services to GPs within a Primary Care Network to help understand issues in people's lives and try to address them without the need for clinical intervention. It has also worked in partnership with its local Youth Advisory Board to invite young people to describe their mental health challenges and used this to commission the Cup-O-Tea service, a non-profit mental health organisation, which delivered low level mental health support to children and their families and helped prevent crisis escalation. 

The council has also received £140,000 to join the Government Healthy Homes scheme which is used to improve staff training and acquire better equipment, while improving education and engagement with residents and landlords around tackling damp and mould and preventing resultant health issues. 

‘We were able to give people the technology to identify what was causing their house to be damp or mouldy and better educate them on how best to dry clothes in their homes and helped address poor living conditions and living standards if they were in private rented accommodation,' James explained. 

The director said increasing numbers of people with mental health issues presenting in housing need had highlighted the importance of looking at healthcare ‘as a whole system'.  

‘Some people are in a challenging housing position because they have poor mental health but others have poor mental health because they are in a challenging housing position,' James explained.  

‘We need to understand that people's lives are complicated. We need to work with our providers and our communities to get help earlier.' 

Breckland also works closely with county sports partnership, Active Norfolk, to promote all age active lifestyles. Through its Health and Wellbeing Partnership the council also works with voluntary organisations such as Menscraft to help improve men's mental health through initiatives such as Men's Sheds. Breckland also recently created two community alcohol partnerships that help maintain healthy alcohol consumption levels. 

Prevention  

The primary role of prevention in improving public health has been an ever increasing focus for the council but how is it possible to measure progress in this area? 

‘Prevention is one of the most difficult things to be able to measure and evidence,' James acknowledged. 

‘It's really hard to prove what hasn't happened when you have prevented it. A lot of it has to be around participation and who you are engaging with. A lot of it is about how many people can we engage to be mental health champions.' 

The executive director cited Breckland's community health and wellbeing workers initiative where it was able to measure successful early intervention. 

‘We were able to track through GP records where community workers had engaged people who had never had a vaccination before,' James explained. 

‘The NHS estimated we had saved the whole system about £650,000 in the first 12 months through these interventions.' 

Obstacles  

When asked for the biggest obstacles to effective partnership working on health, James cited ‘the ability to share data', adding he had seen ‘a real will now to overcome that'. 

The executive director offered the council's community and health wellbeing workers project as an example of successful data sharing, while stressing this needed to be scaled up. 

‘We need to find ways in which we have one view of our resident because people's lives are complicated,' James stressed. ‘There's no point in a GP or hospital dealing with a resident who has a respiratory condition and medicating them for that condition and then letting them go home to a damp and mouldy house. 

‘We should have a joined-up view on our people and that is the ambition of the Integrated Care System in terms of how we are then better able to align all our resources and get better value of money and outcomes for our residents.' 

If you would like to appear in The Big Interview email Lee Peart at l.peart@hgluk.com