Population Health refers to improving the health of an entire population, improving the physical and mental health outcomes and wellbeing of people, whilst reducing health inequalities within and across a defined population. It includes action to reduce the occurrence of ill-health, including addressing wider determinants of health.

The wider determinants of health such as where we are born, grow up, live, work and age, as well as the decisions we make for ourselves and our families, collectively have a bigger impact on our health than healthcare alone.

As a partnership we aim to address and reduce these health inequalities across Walsall.

As well as the overarching aim of the partnership to do this, the Clinical Professional Leadership Group has set out its plans to ensure that, all their areas of responsibility and programmes of work centre on the following themes:

  • Reducing variation in outcomes
  • Identifying and overseeing implementation of our priorities as anchor institutions
  • Ensuring the COVID restoration and recovery does not exacerbate health inequalities

There are a number of other initiatives that are underway which you can read more about below.

Population Health Management (PHM) put simply is using data (for example on how many people smoke, have dementia or have diabetes) to help us understand our current health and care needs as well as predict what will be needed in the future

In Walsall we have worked closely with our seven Primary Care Networks (PCNs) as well as our public health and housing colleagues to undertake a review of the needs of their local communities including what matters most to them, based on the quantitate and qualitative data they hold. This includes health data and information on the wider well-being needs including those such as housing, education, employment, mental health.

This information will be used to identify priorities and deliver services at a local level.

We are currently developing a Population Health and Inequalities Strategy which will set our how we plan to reduce health inequalities. It will align to the priorities set out by the Health and Wellbeing Board (HWBB) and the development of the Walsall Health and Wellbeing Strategy.

This work will be further enhanced by the roll out of a Population Health Management digital segmentation tool.

There are lots of different clinical computer systems across Walsall.

They all hold clinical information about patients who have used services provided by their GP, at a local hospital, community healthcare, social services or mental health teams.

Each record may hold slightly different information about a patient or individual using a particular service.

When people visit different organisations, for different aspects of their health or care needs, their records don’t always go with them and the person delivering the care can’t always access the most up to date information.

This means people often have to repeat their medical history and the professionals spend a lot of time checking vital information such as current and past treatments, test results and allergies with patients themselves or with other care providers. It also creates the potential for important information to be missed making it harder to provide good quality and safe care.

In Walsall we are creating a shared cared record to help us deliver a seamless and joined up service. 

This is a secure way of allowing a professional to access to the most up to date and relevant information so the person they are caring for receives the best possible care in the quickest possible time wherever they are.

We have also been working with the people who deliver services in Wolverhampton so we can share records across both areas. This means anyone who receives care in Wolverhampton will have their information accessed in the same was as they would in Walsall.

In order to achieve this all the organisations in the partnership have signed an agreement that clearly sets out the reason for sharing data and their role and responsibilities in ensuring they are meeting legal requirements to keep the information safe.

Work is now underway to upload the relevant information onto the new shared system.

We plan to run a pilot of the system in the summer of 2021 with a full roll out expected to be completed by the end of 2021. 

The animation below has been developed by the Kings Fund.

What is a 'population health' approach? And what role do we all play in keeping our communities healthy?