Central London Community Healthcare NHS Trust has published a plan of action for population health and neighbourhood infrastructure, outlining a shared outcomes framework to support collective leadership, along with four proposed neighbourhood health aims aligned with the National Neighbourhood Health Framework.
Sharing an ambition to develop neighbourhood infrastructure as a strategic capability and provide the foundations for integrated working at place level, the trust looks to establish a consistent integrated neighbourhood model across all places, using population health management to reduce inequalities and improve outcomes, and optimise care pathways to be person-centred, proactive, and neighbourhood-based. A focus will be placed on agreeing a core neighbourhood dataset and reporting pack, it continues, with shared insight to support case finding, and digital tools supporting access and joined-up working.
“Clinical outcomes will become a core component of organisational assurance alongside productivity, safety and operational measures,” the trust states, with outcomes to be measured incorporating activity, waiting times, productivity, capacity, patient experience, patient safety, PROMs, and health improvement. A clinical outcomes dashboard will be created to support “four increasingly sophisticated conversations”: whether patients are improving, who is improving, where improvements should be made, and how to improve population health.
A federated approach is put forward, with every partner leading where it adds greatest value, and an integrator bringing partners together into a single place outcomes framework and aligning priorities. Four initial neighbourhood aims are highlighted: hypertension detection and optimal treatment; diabetes detection, management, and complication prevention; reducing avoidable acute admissions with proactive care, rapid response, and admission avoidance; and improving timely discharge to community settings, supporting more people to recover safely at home. By March 2029, CLCH hopes to have increased Hospital at Home capacity by 20 percent.
A bi-annual update is also offered on the CLCH digital strategy to 2030, with key deliverables to date including work to deliver patient portal access across SystmOne that has resulted in reductions to DNA rates and increases in available appointments; and an evaluation of AVT resulting in a 40 percent average reduction in documentation time, leading to a business case. The board details progress in rolling out a variety of apps to aid clinical delivery and planning, including in image handling and scheduling.
A pathway to delivering patient portal access via the NHS App for both core clinical systems has now been developed, with the Zesty portal procured and migration plans from the existing DrDoctor contract being agreed with the new supplier for 2026. A workforce scheduling solution capable of integrating with SystmOne and EMIS is being used for urgent community response and virtual wards across North Central London, using real-time data to support capacity and a move to collaborative staff resourcing. A bid has reportedly been submitted to see whether the trust can extend the service to other divisions.
Wider trend: Population health
Leicester, Leicestershire and Rutland ICB and Northamptonshire ICB’s latest five-year strategic commissioning plan to 2031 highlights the move from short-term recovery to longer-term transformation, outlining the role of digital and data in areas such as population health, neighbourhood health, and prevention. The ICBs also share that a new digital and data strategy is expected in September 2026, with a data quality strategy to follow by March 2027. Core commissioning ambitions include improving access and flow for elective care, urgent and emergency care, and neighbourhoods, the ICBs state, modernising pathways, reducing variation, and relying on digital connectivity and shared care records to help deliver care closer to home.
University Hospitals of Liverpool Group is seeking feedback on its five-year strategy developed using population health data – “a once in a generation opportunity to make bold changes and transform patient care for the future”. Chief executive James Sumner commented: “We need to think differently about the way we work and take a totally different approach if we want to shift the dial and make things better for our population. This is your opportunity to take a look at our proposed plan for the next five years. It outlines the challenge and what we need to do, but we need your support in starting to think about how we do it.”
The Derby & Derbyshire, Lincolnshire, and Nottingham & Nottinghamshire (DLN) ICB cluster has published a five-year strategic commissioning and population health improvement plan, detailing the role of digital in supporting system ambitions to 2031. DLN notes a “decisive shift” from traditional commissioning to a “should cost/should deliver” model with focuses on the three shifts toward prevention, care closer to home, and digital. “Strengthened data, intelligence, and digital innovation will underpin this more mature population health management approach, enabling targeted action to improve outcomes and reduce inequalities,” it states.
