Development of IJB Strategic Plan 2025-2030

We will prioritise the delivery of services to improve health and social care outcomes for those most disadvantaged in our communities and will work with partners to address the factors that contribute to health inequalities.

Delivery priorities

• 3.1 Working with partners to support a whole system approach to tackling health inequalities
• 3.2 Delivering services that contribute to reducing inequality
• 3.3 Prioritising service delivery at the level needed to keep people safe and to reduce the risk of harm
   

Why is this a strategic objective for the IJB?  

We know that there are health inequalities in East Lothian.

• Evidence shows that people living in parts of East Lothian with higher levels of deprivation and / or with other disadvantageous living circumstances, have significantly poorer health outcomes.
• There are a range of socio-economic and other factors, often described as the ‘wider determinants of health’, that impact on health outcomes – these include, poverty, education, housing, employment, and access to services. It is suggested that as much as 80% of what effects health is out with the health and social care system.[1] 

The IJB must ensure that the services it is responsible for contribute to improved outcomes for all and that it contributes to a whole system approach to addressing health inequalities:

• The IJB has responsibility to ensure that health and social care services delegated to it are resourced, planned, and delivered in a way that ensures they are accessible to everyone. 
• Importantly, a number of services delivered by the HSCP meet the specific needs of the most disadvantaged groups in our communities - for example, Substance Use Services; Justice Social Work; Adult Protection; and Learning Disability Services.
• The IJB needs to ensure that these key services continue to be prioritised and adequately resourced in order to keep people safe; to prevent harm; and to reduce disadvantage.    
• Many of the services that directly impact on socio-economic outcomes do not fall within the IJB remit. However, the IJB has a role to play in the whole system approach needed to address health inequalities.

Health inequalities need to be addressed by working with partners as part of a ‘whole system approach':

• Because of the range of contributory factors, health inequalities need to be addressed by community planning partners working collaboratively, both strategically and operationally.
• This is reflected the in the Scottish Government Population Health Framework’s guiding principle of delivery ‘through a whole system approach – nationally and locally’.   

References

[1] Scotland’s Population Health Framework 2025-35.
 

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What do we need to prioritise to deliver this strategic objective? 

Focusing on the strategic delivery priorities below will help us to achieve this strategic objective. Further details, including timescales and targets, will be included in Annual Delivery Plans developed for each year of the Strategic Plan. In addition, there are a number of strategies / programmes already in place, or under development, that will provide direction (these are highlighted in bold italics below).

As well as the priorities below, the operational delivery of HSCP services will continue to contribute to achieving this Strategic Objective through existing activities and approaches that focus on achieving better outcomes for all service users.      

3.1 Working with partners to support a whole system approach to tackling health inequalities

As noted above, health inequalities are the result of a range of socio-economic factors collectively known as ‘social determinants of health’. These include factors that are impacted by services that are not the direct responsibility of the IJB (for example, education, housing, welfare, and employability services). However, given the need for a whole system approach to addressing health inequalities, priority needs to be given to working with partners both strategically and operationally to help address the issues that result in poorer health outcomes.      

Specific activity required over the lifetime of the Strategic Plan will include:

• Developing IJB / HSCP participation in Community Planning and other Strategic Partnerships to develop a whole system, collaborative response to the issues that negatively impact on health outcomes (including through involvement in the development and delivery of the East Lothian Partnership’s Local Outcome Improvement Plan).
• Working with partners through the Housing, Health, and Social Care Strategy Group to drive collaborative working in relation to the Housing Contribution Statement.
• Working with Public Health Scotland partners to build upon our understanding of population health data to help inform service development and prioritise the use of resources (including through the ongoing development Strategic Needs Assessment work).

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3.2 Delivering services that contribute to reducing inequality

We have a direct responsibility to ensure that the health and social care services we deliver are appropriate and sensitive and that they have effective arrangements in place to ensure that the most vulnerable and potentially excluded groups in our communities are able to fully benefit from them.

Prevention and early intervention from pregnancy, through to early years, and on into childhood and adolescence is important in terms of improving overall population health, leading to better health outcomes throughout adulthood and reducing health inequality.

Although children’s social work services are not delegated to the IJB in East Lothian, there are a number of HSCP healthcare services provided to children and families (including, for example, primary care services; health visiting; and school nursing). HSCP services also work with parents and other adults within families, so are part of the multi-disciplinary approach to supporting the whole family. 

Specific activity required over the lifetime of the Strategic Plan includes:

• Carrying out robust Integrated Impact Assessments (IIAs) to identify potential adverse impacts of service changes or developments on people with protected characteristics or those potentially disadvantaged due to other factors.   
• Delivering the equalities outcomes detailed in the East Lothian IJB’s Equalities Outcomes for 2025-29 and reporting on progress through publication of annual Equality Mainstreaming Report.
• Continuing to develop service models and approaches that increase the accessibility of services for the whole population (see 2.2 above).
• Continuing to strengthen partnership working at an operational level, working with colleagues from across organisations to develop and deliver collaborative approaches to identifying and responding to individual need.
• Ongoing development of HSCP teams involvement in multi-disciplinary working across services and organisations to deliver ‘whole family support’, providing families with effective, early help.   
• Ongoing activity, including staff training and development to ensure that our services are Trauma Informed.[2]

References
[2] Trauma Informed services ‘recognise where people are affected by trauma and adversity, and that respond in ways that prevent further harm, support recovery, address inequalities and improve life chances’  - more information can be found here.

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3.3 Prioritising service delivery at the level needed to keep people safe and to reduce the risk of harm

As noted above, continuing to ensure that key frontline services can be delivered at the level needed to keep people safe and reduce the risk of harm must be an overarching priority for the IJB. This includes the provision of statutory social work functions which are crucial in meeting the needs of some of the most vulnerable and disadvantaged groups in our communities.

Specific activity required over the lifetime of the Strategic Plan will include:

• Ongoing monitoring and oversight to ensure that service provision can effectively meet demand.
• Continued development of services to keep people safe and reduce harm, including in relation to prevention and early intervention approaches (see Strategic Objective 2 above).
•  Strengthening of collaborative and multidisciplinary working to identify and address individual needs.

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