Performance metrics to evidence the impact of INTs and the neighbourhood health service across London’s region, five systems, and associated place partnerships will:

Develop a consistent approach to understanding and measuring performance at a neighbourhood level in London.

Performance metrics will be designed around the agreed outcomes of the INTs, ensuring INT partners across the system are working toward aligned goals, have the same view of performance, and can understand impact in the areas that matter. This will include comprehensive outcome metrics, (qualitative and quantitative), encompassing the following key impact domains:

• Prevention, population health including social wellbeing, and wider determinants:
  • Early case identification, long-term condition management, and complex community-based care management;
  • System impact including activity levels across INT partners (such as social care, acutes, and VCFSEs);
  • Staff and resident experience, including continuity of care;
  • Community impact (including social capital);
  • Workforce impact including workforce capacity, skill, and utilisation, (this data must be collected across the system to redress the dearth of workforce data in community settings);

• Population health management analysis which segments the population using a standardised all-age London-wide segmentation approach. This will group the population into cohorts with specific health and care needs, reflecting different forms of preventative and direct support. A standardised segmentation approach, such as that developed by Johns Hopkins, will help to facilitate integrated working between individuals, professionals, services and systems across London by establishing a shared language and understanding of their requirements.

• Identification of priority groups including those affected by inequalities. Priority groups should align to agreed local and system priorities and key outcomes.

• Mapping of data associated with each population segment at a granular geographical level, (down to LSOAs), to build a picture of need across a locality. As a minimum, data should include:
  • Population distribution;
  • Associated service usage and activity such as unplanned admissions and primary care contacts;
  • Demand drivers such as the prevalence of frailty or long-term conditions, or wider determinants;
  • Looks to understand geographic trends, variation, and their drivers, including any measures of engagement/disengagement with health and care services, for example around screening and immunisation levels;

• Application of the following key principles:
  • Continuous learning and improvement: PHM analysis will be ongoing as population needs evolve and respond to INT interventions.
  • Whole population approach: PHM will deliver comprehensive insights and analysis for all ages and communities within a locality, enabling whole-system response.
  • Systems thinking: approaching problems by looking at them as part of a larger system, rather than just their individual parts.
  • Equity focus: PHM analysis will seek to identify and understand inequalities in health outcomes across a geography.
  • Transparency and ethical data use: with clear and shared messaging around the data being used and the uses it is being put to, aligned to population health priorities and needs.

We will make space for INTs to test, innovate, and respond to changing need with updated performance management regimes that allow for metrics and KPIs to evolve alongside INTs, creating the space for failure and improvement.

We recognise the challenges of measuring community-level impact. Evidence has shown that the impact of neighbourhood working on hospital care may only present years down the line. Performance metrics will need to capture preventative, community impact recognising that more reporting and increased proactive care may increase activity in the short term; and that community interventions may appear in diffuse ways in the data.

To overcome these challenges, we will embed both quantitative and qualitative data collection in the support to neighbourhood teams. Qualitative data, including feedback and case studies, will be essential to evidencing progress and ensuring learning is not lost, undervalued, or overlooked in funding and resource allocation.

We will ensure reporting requirements are not prohibitive or obstructive to any organisation within INTs. Monitoring frameworks within the neighbourhood teams will be seen foremost as tools to support best practice, provide the right level of assurance, gather evidence, and nurture local approaches.

Begin with developing a shared view of what our INTs will achieve for communities and the partners that support them.

Metrics will be embedded into INT visioning and outcomes development from the beginning. These will draw from existing metrics and insight gathered locally/by communities, alongside standard regional and national data.

Systems will be expansive in sourcing outcomes data and make best use of the breadth and depth of existing information in the community to build a comprehensive picture of impact.

We will ensure a degree of comparability between INTs, places and systems to understand and shape performance on a regional level. A degree of standardisation will provide the minimum assurance needed for INTs to be able to pursue locally tailored initiatives whilst delivering their core responsibilities.

Any performance comparison will take into consideration local context, such as resource availability and baseline local population health. To develop meaningful learning will require a deep understanding of the population, with the right data integrated to build a clear and up to date view of the population and where there is need, and in order to identify where INTs are having impact.

We will develop concise reporting requirements which are proportionate to each partner and the scope of the service, recognising that detailed evaluation requirements may be prohibitive for some impactful community-led schemes.

We will enable a culture of evidence gathering and rigorous and rapid evaluation as part of the INT “test and learn” approach. This will inform future planning, design, and service delivery; support the understanding and socialisation of good practice; ensure INTs develop sustainably; and will ensure impactful services and initiatives are able to secure funding into the future.