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As the borough with the second largest population in London, Croydon faces multiple healthcare challenges.
Director of public health Rachel Flowers talks to Léa Legraien about the initiatives the council has implemented to improve the health of its residents.
Q What challenges are you faced with in Croydon?
The challenges we’ve got in Croydon are pretty much the challenges an area with a large number of people and inequalities has: the money we have doesn’t reflect our complex, growing population.
Our population is getting older. It’s a diverse community with many comorbidities and the health inequalities across the borough mean we’re seeing a 10-year difference in life expectancy [86 year for men in Selsdon and Ballards compared to 74.4 men in Selhurst].
Nearly 6,000 children are born [in the borough] each year. Croydon has [a rapidly growing population] and we’re collectively working with the community and the health service to make sure this is a healthy growth that benefits everybody.
It’s about ensuring we deliver the right services at the right time and in the right place. We don’t want anybody left behind.
Q How is Croydon working to reduce health inequalities?
Public health is important within Croydon council. Our operating model focuses on prevention and looks at the wider determinants of health. One of the reasons many of us advocate public health functions is that most of the levers that impact on the health and wellbeing of the individuals in the communities are within a local authority setting.
We have a multi-agency partnership called One Croydon Alliance where we collectively work with people over the age of 65 to make sure they get the right support to keep them out of hospital or make sure they only remain in hospital for a short period of time.
The alliance is a health and care partnership looking at outcome-based commissioning to improve the health and lives of older people in Croydon. There are six organisations involved including the council; Croydon Health Services; Croydon GP Collaborative; Croydon CCG; South London and Maudsley Foundation NHS Trust and Age UK.
Q What changes have your initiatives led to?
The early changes we have are those of the Integrated Community Networks (ICN), a multi-age team that works to manage the care of people with complex needs; with social workers, Age UK, clinicians and GPs. We’ve also got the Living Independently For Everyone (LIFE) team, an integrated reablement and rehabilitation team that supports hospital avoidance and joined-up care.
Another important part is the personal independent coordinators – [which consists of people visiting older patients in their own homes to identify and achieve personal goals and find new activities and support services, among other things.]
We’ve had people stuck in their house who couldn’t go upstairs because they were scared and who needed to go out and connect. We’re working with this group to see how we can support them to make a change in their lives.
About half of the people we’ve engaged with didn’t really need healthcare intervention, [what they needed was] social contact because they were isolated.
We’re already seeing a return on investment: about £1.44 for every pound we spend under the ICN model and over £2.50 with the work around LIFE. We’re making a real difference. For us, it’s not about the money it’s about the people.
Q How have the Government cuts to council budgets affected Croydon?
Many of the challenges in Croydon and elsewhere are about the lack of understanding that local authorities are key deliverers of services that improve and protect the health of populations. We’re trying to use [these cuts to promote] a collective approach to improving the health of the population.
In terms of the ringed-fenced public health money, there has been a 9.9% reduction over four years, at a time where the Government is increasing spending on the NHS. All the money a local authority spends has an impact on the health and wellbeing of its people.
This year, I had to find [savings] of just under £2m, [with an overall budget for public health in Croydon] in the region of £21m. [The budget] was bigger last year and the year before but will be smaller next year. Every director of public health and local authority in the country is having the same experience.
Q What is the council doing to tackle obesity?
We’ve been developing a plan around some of the good practices in the Food Flagship programme but also the Sugar Smart and the Daily Mile [initiatives: the former designed to make people more conscious of the dangers of consuming too much sugar, and the latter to encourage schoolchildren to exercise for at least 15 minutes a day] and a wider piece of work with businesses.
We continue to work very closely with schools. I was at the Rockmount Primary School last week, one of the first Food Flagships, where they are looking at giving young people skills when it comes to knowing where the food comes from, growing their own food, looking at the food they eat at school and [preparing] healthy packed lunches for school.
We’ve also increased the number of people who are eligible for free school meals. Combined with that, we’re working on a food poverty strategy, particularly in the New Addington area. The reality is that some people are finding it hard to make ends meet so we’re working with them around affordable food and helping them with their budget.
With these approaches in schools, we’re starting to see a reduction in obesity. We’re working with a range of partners, including communities and the CCG, to look at how we can [create] significant behavioural change. It’s a whole system approach but it’s also about lobbying hard nationally and working with the Greater London Authority and wholesalers on what they can do.
The important thing for me is sustainable and long-term behavioural change. We need to get people to move more and eat a little bit better, and not just because it’s an initiative.
Q What is in the pipeline for the council in 2019?
Quality-based work around prevention. We have focused on the over-65s, we’re now looking at children. The council has a very good model around Gateway Services, which is working with local people to help optimise their [welfare] benefits and make sure they get the right service at the right time.
We’re also looking at how we can provide a digital offer to support people. Much of what we’re doing is informed by good practice. I’m not just interested in what is said in theory – I’m interested in how we can deliver collectively to make a difference for the people of Croydon.