As the fourth largest county in England, covering 5,921 square km and with a population of 768,400, Lincolnshire is home to an ageing population and localised areas of deprivation.
Lincolnshire has its own challenges when it comes to health and wellbeing; statistics indicate that that 67.6 percent of its adult population is obese and 15.4 percent of children live in low-income families.
The 2023 Lincolnshire Integrated Care Partnership (ICP) Strategy has the ambition “for the people of Lincolnshire to have the best possible start in life, and be supported to live, age and die well.”
To achieve this ambition, the strategy identifies four key aims to set strategic direction up to 2025: to focus on prevention and early intervention; to tackle inequalities and equity of service provision to meet population needs; to deliver transformational change in order to improve health and wellbeing; and to take collective action on health and wellbeing across a range of organisations.
Key components and drivers
The ICP strategy is designed to compliment Lincolnshire’s Joint Health and Wellbeing Strategy, with the former focused on the ‘how’ and the latter focusing on the ‘what’. The ICP strategy outlines the priority enablers which will inform and direct Lincolnshire’s health and care system, including population health and prevention; workforce and skills; personalisation; community engagement and involvement; and data and information systems.
Ischemic heart disease (IHD) is identified by the strategy as “by far the highest cause of death in Lincolnshire”, followed by lung cancer, stroke, COPD and Alzheimer’s.
The number of years that people are living with a disability in Lincolnshire has increased over the last 30 years, at a rate which is higher than both regional and national averages.
The biggest driver of risk for disease in Lincolnshire is identified as behaviour, which is one of the factors shaping the strategy’s prevention and intervention activities.
“Whilst life expectancy has increased for the people of Lincolnshire, those extra years of life are not always spent in good health. An increasing proportion of people are living with multiple long term conditions, some for decades. The combination of an older and further ageing population, rural geography and areas of high deprivation defines the specific challenge of delivering high-quality and effective health and care across the county.”
In terms of socio-economic outcomes, Lincolnshire has high unemployment rates and persistent skills gaps, with rurality and access to employment opportunities causing barriers in some cases.
The strategy also acknowledges that there are around 200 caravan sites, and nearly 25,000 static caravans on the Lincolnshire coast, said to be the largest concentration in Europe, with a permanent population of over 6,000 people. The ICP estimates that around 30 percent of local caravan residents “live with long-standing illness, disability or infirmity and nearly a quarter have health issues affecting mobility.”
Population health and prevention
“Addressing the wider determinants of health will help improve overall health by helping to improve the conditions into which people are born, live and work,” the strategy states. “Addressing these determinants throughout the life course allows us to consider the critical stages, transitions, and settings where large differences can be made in promoting or restoring health and wellbeing.”
Under the umbrella of population health and prevention, the strategy identifies four key themes: preconception, infancy and early years (0-5); childhood and adolescence (5-19); working age (16-64); and ageing well.
Preconception, infancy and early years (0-5)
Interventions planned under this theme include building awareness of screening before or during pregnancy; ensuring vaccinations pre- and during pregnancy are up to date; promoting the use of folic acid and supplements in pregnancy; supporting healthy diet and exercise; encouraging giving up smoking; improving speech and communication skills in under fives; prioritising early intervention; and increasing uptake of childhood vaccines.
Childhood and adolescence (5-19)
The strategy sets out interventions for this theme including tackling vulnerabilities and ACEs; supporting young people’s mental health and emotional wellbeing; improving educational attainment; increasing motivation for physical activity; tackling tobacco, alcohol and drug use; and reducing the number of teenage pregnancies and improving outcomes for young parents and their children.
Working age (16-64)
Planned interventions under this theme include working with employers to grow a healthier and highly skilled workforce; improving mental health and wellbeing; and preventing MSK conditions by encouraging people to stay active and healthy.
Ageing well
Interventions planned under this theme include improving access to good employment; protecting health through improving housing and the built environment; increasing awareness and uptake of vaccinations; preventing falls; maintaining functional ability; and preventing loneliness and social isolation.
Workforce and skills
“Public sector employment, including health and care, underpins the local economy in Lincolnshire,” the strategy states. “The health and care sector is vital for employment locally, and we know through work led by the Greater Lincolnshire LEP there is an existing and growing demand for workforce and skills levels that cannot be met by the current working age population.”
The strategy explores two key themes in this category: to inspire and support young people to stay and work in the area; and to train and support people who are already working, or seeking jobs, so they gain the skills needed to take up future job vacancies.
To inspire and support young people to stay and work in the area
Planned interventions in this area include: continued expansion of the Enterprise Adviser Network, increasing the number of advisers and working on linking into school career programmes; and promoting opportunities and careers in the local health and care system with support from the Greater Lincolnshire Careers Hub, improving information about local jobs and careers so young people can more easily access it.
To train and support people who are already working, or seeking jobs, to gain skills to take up future job vacancies
Interventions to support the development of skills and support the workforce include developing skills priority statements for the health and care sector to maximise future opportunities and focus on upskilling or retraining residents; encouraging businesses to develop workforce and skills strategies; and building on the recommendations of the digital skills workshop to develop a plan specifically for the health and care sector.
Personalisation
“Our aim is to shift the relationship and conversations between people, professionals and the health and care system to one which focuses on people’s strengths and assets and ‘what matters to them’, providing a positive shift in power and decision making that enables people and those who are important to them to have more choice and control to be able to live their best, and healthiest life – the life that is important to them and their loved ones.”
The strategy focuses on the publication of a ‘shared agreement’ that describes the evolved relationship between the health and care system and the people of Lincolnshire, rooted in partnership, personalised care and shared decision-making. Themes identified include: shared decision-making and ‘What matters to you?’ conversations; supported self-care and self-management; and wellbeing, social prescribing and community based support.
Plans within this part of the strategy include: driving change in current culture and systems to encourage shared decision-making across the ICP; preparing and supporting residents to feel confident in embedding personalised care and shared decision-making; ensuring strong professional and executive leadership, and that all relevant organisations ensure strength-based personalised care is an integral part of their recruitment, induction and training; and ensuring that everybody who wants a personalised care and support plan has one the they can view and contribute to digitally.
Supported self-care and self-management
Interventions shared under the supported self-care and self-management section of the strategy include putting in place a range of staff such as health and wellbeing coaches who can take a supportive and non-judgemental approach to helping people become advocates for their own care; encouraging peer support so that people with similar health and care experiences can support each other to better understand their recovery or self-management; and working with people to help them develop the skills and confidence they need to manage their own health and wellbeing effectively.
Under wellbeing, social prescribing and community-based support, the ICP commits to enabling health and care professionals to link the people they see with someone who will help them explore “what matters to them”, supporting them in a holistic way; ensuring Lincolnshire has a sustainable and resilient social prescribing offer through jointly commissioning and supporting the voluntary and community sector; involving people with lived experience at every stage of development to co-design services and information; and working in an integrated way alongside other commissioned services such as health lifestyle support, carers service and Lincolnshire’s Wellbeing Service, identifying opportunities to enhance community-based provision and digital development.
Community engagement and involvement
“Community support networks can play a vital role in enabling communities to flourish and play a vital role in ensuring that our residents are able to be healthy and live well. Communities are usually best placed to solve the specific challenges they face. We can help to ensure that the right support and facilitation is in place. We want to see our communities being better able to bring about the changes they want to see.”
The strategy hopes to work with communities to remove unnecessary obstacles and bureaucracy and to direct limited resources where they can have the biggest impact. In doing so, it covers the following themes: consultation, engagement and collaboration; community networks; volunteering; funding for our communities; and tools and data.
Under consultation, engagement and collaboration, the strategy aims to work closely with communities to hear their views and keep them up to date with improvements; have more community based conversations, empowering people to get involved in decision making; develop relationships with community groups to influence decisions and enhance the community voice in work that is done; and ensure decision makers have access to more current and meaningful data about communities and their wishes.
In terms of community networks, the strategy will: establish a clear framework for engaging with community networks; use this framework to shape the way services are delivered; do more to develop connections with communities to promote shared understanding; understand where gaps in provision exist; help communities become stronger and more self-sufficient; and develop clear engagement plans to let people know what is happening and how they can get involved.
Recognising the importance of volunteering to Lincolnshire communities, the strategy includes plans to develop more robust arrangements by working across sectors to support training, development and volunteering opportunities; and encourage partners to get involved and support community initiatives.
Recognising an increased need for services to support residents since the pandemic, the strategy aims to work collectively to review the effectiveness of current approaches by looking at how funding to voluntary sector infrastructure bodies is used; identify opportunities to learn from best practice; engage nationally to attract more investment to Lincolnshire, as well as to ensure that funding is distributed to achieve maximum impact; and enhance the content of the Lincolnshire funding portal.
To promote open dialogue with communities, the strategy hopes to continue to train and develop teams to get the most out of engagement activities; embed new approaches to engagement; improve information sharing practices; standardise approaches and increase the number of participants in dialogue; and develop policies and practices that have the voices of communities at their heart.
Data and information systems
“The plans and actions of the Lincolnshire ICP will bring about significant changes in the way individuals receive care. Service users together with those organisations involved in the provision and delivery of health, care and wellbeing will all need to behave differently to achieve the improvements to which we aspire. Data and Information Systems will be key in supporting behaviour change by informing and supporting the delivery of care, decision-making, and enabling better outcomes for people.”
A focus on information and information sharing prompted the development of two themes: supporting people, and supporting health and care professionals.
To support people, the strategy plans to utilise digital technologies to enhance people’s experience of accessing services, through providing access to own care record and care plan; promoting self-management via digital tools; encouraging communication and engagement with professionals such as their Care coordinator; and providing access to information, advice and services online.
In terms of supporting health and care professionals, the strategy sets out ways to help local health and care professionals to adapt to the new more integrated ways of providing care. Some of the steps toward this will include ensuring that professionals have the data and tools they will require to understand the Lincolnshire population and their needs; provide new ways to monitor outcomes; help to identify service users requiring attention; support local Care Coordinators in the care planning process; ensure local care teams are alerted to relevant events so they can response to specific needs in a timely fashion; and provide remote monitoring capabilities to support user empowerment and the ability of individuals to receive appropriate care in their home.
Planned delivery
The Lincolnshire ICP will have oversight for delivery of the new strategy, and to put in place the appropriate governance arrangements to assure upon the delivery. The strategy is also likely to continue to be developed as plans and thinking evolve.
“Once the JSNA is republished in March 2023, further engagement and development will take place to refresh the JHWS for Lincolnshire and inform further development of the Integrated Care Strategy. Both strategies will be produced by December 2023.”
To read the strategy in full, please click here.
