The Population Health Management approach in ICSs pays homage to work of Florence Nightingale

As we reach this key milestone of 1 July it got me thinking about Florence Nightingale’s work during the Crimean War and how her intelligence helped those most in need.

Integrated care systems, as they continue their journey of development, are actually about extending people’s healthy life expectancy so they can live their best lives.

Florence realised she couldn’t have any impact on the 2,700 soldiers killed in battle but she could have a huge impact on those dying of preventative disease.

She was a social scientist and understood health status is related to living conditions like home ownership, employment and income.

She was also a passionate statistician and placed huge importance on the visual presentation of information, she was the first woman to be inducted into the Royal Statistical Society in 1858.

Florence took a Population Health Management (PHM) approach in using health data to understand how physical and social risk factors influence health.

She made an enormous contribution to the foundations of evidence-based nursing as well as the establishment of a public healthcare system.

Fast forward to 1 July 2022 and here we are trying to make PHM business as usual for the health service, working in partnership with local government and the voluntary sector through ICSs.

At the heart of system working is a Place-based model which will ensure the needs of individuals and communities are at the heart of planning, decision-making and co-production.

This will help us break down some of the organisational boundaries that have previously existed.

And simply put that’s because in every Place there is a team of Florence Nightingales – GPs, nurses, analysts, hospital consultants, public health specialists, volunteers – who know where preventative disease exists.

They understand how physical and social risks affect people’s health and how they can make the most impact through more integrated, proactive and personalised care.

The enormous benefits of closer partnerships within integrated care systems has led to crucial linked-data emerging which is highlighting the highest risk and most underserved population groups.

Health and care professionals using a PHM approach are regularly amazed at what the data can tell them and how this transforms their service models. As a GP I can talk testament to the work.

In Gloucestershire, for example, we used a PHM approach with our COVID-19 virtual ward to stratify, segment and target certain groups at risk of deterioration, giving them a pulse oximeter plus admission to the virtual ward. This allowed early identification of deterioration and timely escalation.

The intervention was simple but finding and reaching those at risk took thought and partnership working. We also used PHM to help children and young people with mental health problems after COVID-19. By supporting such groups more effectively, we can improve their lives and free up resources.

These are just two examples of thousands happening across the country.

PHM isn’t an extra project. We must see it as the way of working across place-based teams, helping systems tackle their burning platforms, reducing people’s workload and bringing joy to their jobs.

As we move past 1 July, PHM must become business as usual at the heart of partnership working, driving the focus on the wider determinants of health.

It will help us target investment and develop new models of proactive personalised care which improve health outcomes and reduce inequalities.

This year’s NHS Planning Guidance asked integrated care systems to put in place the basic building blocks.

For Gloucestershire, we’ve developed a PHM roadmap which outlines how we will develop these:

  1. linked data (increasingly between the NHS and wider partners) so systems can develop a deeper understanding of the needs of individuals and communities
  2. an analytical platform which supports population segmentation and risk modelling so we can increasingly predict future needs and prioritise resources
  3. a system intelligence and improvement function which supports the translation of data into actionable insight for frontline teams – for us, this will require transformation and reorientation of local analytical and commissioning capacity to work differently with neighbourhood and place based teams to develop new service models.

We’re also thinking about the future, how can integrated data and PHM help us project and define the necessary workforce, financial and contractual models to deliver better personalised care?

When I think about how Florence used data it inspires me to think what integrated care systems can achieve with partnership working and analytically driven population-based models of care.

Find out more about PHM at the PHM Academy on Future NHS, sign up here.

Integrated care systems move onto a statutory footing from 1 July 2022.  More information is available on the NHS England website.


Hein is a GP Partner at Churchdown Practice in Gloucester and has recently taken up a role as Deputy Medical Director for NHS England South West as well as being the One Gloucestershire ICS Quality Improvement Clinical Lead. Previously he was the Deputy Clinical Chair for Gloucestershire CCG where he led on ageing well, dementia and end of life amongst other things. He also had a role as the Population Health Management Champion for Gloucester City where he also co-chaired the Gloucester City Integrated Locality Partnership and previously sat on the Gloucestershire Health and Wellbeing Board.

Hein has developed a passion for improving the quality of healthcare experienced by service users and achieved through collaborative working. He has benefited from his experiences of working in several different health care systems including Australia.