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Population Health 2

Population Health

At East London NHS Foundation Trust (ELFT), we are committed to providing excellent clinical care and to improving the health and wellbeing of the communities we serve in Bedfordshire, Luton, Richmond and East London. This commitment is underpins our mission to improve the quality of life for all we serve. 

As seen in the video, for our communities to be healthy and thriving, we need the right building blocks for health in place: stable jobs, fair pay, good quality housing and education. These building blocks are sometimes called the ‘determinants of health’, and they can often have a bigger influence on our health than healthcare services.

ELFT aims to work to ensure the right building blocks are in place to improve health and stop lives being cut short in our communities. Improving population health is central to ELFT’s strategy, as illustrated below.


ELFT Strategy

To achieve our strategic ambition of improved population health, ELFT is working with the UCL Institute of Health Equity to become the first NHS ‘Marmot Trust’, and test the boundaries of what an NHS Trust can do to tackle some of the drivers of poor health, such as poverty and unemployment.

As a mental health and community service provider, we often see service users whose conditions are caused or made worse by poverty, insecure jobs and living conditions. People with severe mental illness (SMI) are dying 15-20 years earlier than they should. NHS Trusts do not usually have the opportunity to influence these building blocks of health, as efforts are wholly focused on reactively delivering clinical care.

Our Marmot Trust programme of work is exploring how a NHS Trust can work more ‘upstream’ to implement the 'Marmot principles' to reduce health inequalities and ensure the right building blocks are in place to improve health, and stop lives being cut short in the communities we serve. ELFT is the first NHS organisation to explore this, which will be important learning for the NHS.

Marmot principles

The Marmot principles are evidence-based policy objectives to reduce health inequalities, which were originally set out in Professor Sir Michael Marmot’s Review, titled 'Fair Society Healthy Lives’,1 published in 2010. Principles 7 and 8 below have been added more recently:

1. Give every child the best start in life

2. Enable all children, young people and adults to maximise their capabilities and have control over their lives

3. Create fair employment and good work for all

4. Ensure a healthy standard of living for all

5. Create and develop healthy and sustainable places and communities

6. Strengthen the role and impact of ill health prevention

7. Tackle racism and its outcomes

8. Tackle climate change and health equity in unison

The Health Foundation defines anchor institutions as “large, public sector organisations that are called such because they are unlikely to relocate and have a significant stake in a geographical area – they are effectively ‘anchored’ in their surrounding community.”2 The infographic below illustrates how NHS organisations can adopt anchor practices in order to use their resources and assets to support the health and wealth of the communities they serve.

What is an Anchor Trust

Figure 1: The role of the NHS as an anchor institution (Source: The Health Foundation, 2019)

At ELFT, we have agreed a set of social value priorities that form a framework for ELFT to progress as an anchor organisation:

•    Ensuring our suppliers pay the Real Living Wage set by the Living Wage Foundation
•    Investment to grow and retention of spend in local economies
•    The creation of equal employment and training opportunities for local people, people with protected characteristics, service users, and groups hardest hit by the COVID-19 pandemic
•    Support for young workers, school leavers and apprenticeship schemes 
•    A commitment to sustainability, including a reduction in carbon emissions 

To date, the focus of the anchor programme at ELFT has been on embedding these social values into procurement. In 2022, with grant funding from the Health Foundation, we are carrying out an evaluation of our work in this area to generate learning and identify best practice in relation to how to embed social values in procurement and contract management.

Going forward, our priority is to further develop the employment pillar of our Anchor programme, in line with our work on implementing the Marmot principle, “Create fair employment and good work for all.”

Links to further resources:
•    Health Foundation 2019 report ‘Building healthier communities: the role of the NHS as an anchor institution’:

OHID Fingertips – Fingertips is a large public health data collection themed into different health profiles: 

Office of National Statisticsthe Health and Social Care page includes information on life expectancy, health inequalities, disability and addiction as well as access to and expenditure on private and public healthcare systems.

A Joint Strategic Needs Assessment (JSNA) is a systematic assessment of the health, care and wellbeing needs of the community, which local authorities have a statutory duty to produce. It is used to inform strategic priorities, as well as future service planning and commissioning. Check your local authority’s website for their most recent JSNA.

At ELFT, there is a range of training and support available to increase the capability and confidence of our teams and service users to improve population health and address health inequalities.
ELFT population health training resources:

  • Pursuing Equity QI programme: In response to the trust strategy to improve quality of life for all we serve, the trust has launched a QI programme on Pursuing Equity, designed in partnership with colleagues from public health, people participation, the trust’s networks and the QI department. The programme is supporting over 30 teams across the trust those wanting to use Quality Improvement methodology to tackle an aspect of equity in their area of work. You can find out more about the programme here:  
  • ELFT Lead programme: There is a population health module in the ELFT Lead programme, a leadership development course for staff, typically in Band 5-7 roles. The population health module aims to increase participants’ understanding of the different populations and communities that ELFT works in and the causes of poor health within them, of ways to describe populations and their health including inequalities, and how as a leader you can support your teams to think about improving the health of local populations. You can find out more about the ELFT Lead programme, and how to apply here.
  • Inequalities Webinar Series: We have produced a range of webinars with experts and health practitioners on different topics related to addressing health inequalities and improving population health since 2020. The Inequalities webinars are available here  

External population health training resources:
 E-learning for Healthcare (e-lfh) platform has a range of free online courses on population health themes, for instance:

1.    Marmot M, Goldblatt P, Allen J et al. (2010). Fair Society, Healthy Lives: The Marmot Review. London: Institute of Health Equity.
2.    Reed S, Göpfert A, Wood S, Allwood D, Warburton W. (2019). Building healthier communities: the role of the NHS as an anchor institution. London: The Health Foundation

The ways that we are trying to improve population health so that our communities are healthier and able to get more out of life.