On 26 November NHSE/I published a paper on its plans for moving forward with Integrated Care Systems in England. Integrating Care: Next steps to building strong and effective integrated care systems across England.
For the uninitiated, this is the policy response to a challenge teams are navigating up and down the country. Some responsibilities for health and care fall to the NHS, and some things are done by local councils. This can create a mess of misaligned incentives, duplication, and fragmentation. Enter the Integrated Care System (or ICS for short) to help straighten things out.
“In an integrated care system, NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS care, and improving the health of the population they serve.” NHSE/I.
NHSE’s proposal aims to formalise the model, putting the ICS reforms on a statutory footing and give them responsibility for planning and buying services. This is an oversimplification, but the move would seemingly repeal aspects of the Health & Social Care Act 2012. For further reading NHS Providers has released a helpful primer.
What the paper says about digital
There are quite a few references to digital in the NHSE/I 40-pager. I’ve extracted them to save you a job.
Starting from the off, there’s a clear strategic intent to put digital & data at the heart of the change. It’s one of a handful of key themes.
“…we will need to devolve more functions and resources from national and regional levels to local systems, to develop effective models for joined-up working at “place”, ensure we are taking advantage of the transformative potential of digital and data, and to embed a central role for providers collaborating across bigger footprints for better and more efficient outcomes. The aim is a progressively deepening relationship between the NHS and local authorities, including on health improvement and wellbeing.”
In addition to this broad strategic intent there are more specific points on digital that are set out as follows:
- ICS’s will have an SRO for digital on their boards.
- ICS’s will need a digital transformation plan.
- There is a responsibility to build digital and data literacy of the whole workforce “as well as specific digital skills such as user research and service design”. And can we just pause for a round of applause for whichever official managed to squeeze that latter clause in. 👏
- Introduce shared contracts and platforms including shared EPRs.
- Develop or join a shared care record joining data safely across all health.
- Build the tools to allow collaborative working and frictionless movement of staff across organisational boundaries, including shared booking and referral management, task sharing, radiology reporting and pathology networks.
- Follow nationally defined standards for digital and data to enable integration and interoperability.
- Use digital to transform care pathways.
- Develop shared cross-system intelligence and analytical functions.
- Ensure transparency of information about interventions and the outcomes they produce.
- Develop a roadmap for citizen-centred digital channels. NB Not sure why this would be different to the digital transformation plan referenced above, but nevermind.
- Roll out remote monitoring to allow citizens to stay safe at home for longer.
What does that mean for local digital capability?
So far so lofty. But what does the team look like that has to be put in place to deliver all of this?
The challenge of doing cross-institution service design in health and care has long been a bugbear of mine and many others. How can you possibly design great services across such a fragmented system? The NHS must be the largest manifestation of Conway’s Law on the planet. So on the face of it I think this reform is A Good Thing. But it will only solve the digital mess if there is also investment in capability at the ICS level to be able to deliver it. The types of people you need to deliver all of the above amounts to really rather a lot of specialist skills. And there are, assuming the website is up to date, 21 ICS’s currently.
Individual trusts, councils, and others will also have their own digital and technology teams. Institutional fiefdoms will still need to be managed, so how to ensure all the relevant organisations have skin in the game and that the whole is greater than the sum of its parts? This will all also need to be executed in the context of national agencies delivering platforms, framework agreements, and inevitable ministerial pet projects.
What should an ICS Digital Team look like?
I guess a lot of this will need working out and no doubt people are on the case as we speak. But my starting points for an ICS digital transformation team would be the following:
- Multidisciplinary: it would contain designers (service, interaction, content); transformation experts; product and delivery people, user research; interoperability gurus; data scientists; IG experts (the ones that enable not block); and experts in the management of commercial IT contracts. It would also definitely have some technical architects (not armchair architects, ones that can still write code) and developers.
- Empowered, within some well understood and enforced guardrails delivery teams need to have clarity of purpose but freedom to act. There needs to be an agreed patch for sensible service design, and this feels most achievable at the ICS level. Teams should be autonomous to work within that. But there should also be some rules around what gets built or bought, based on the NHS design standard and use of common NHS platforms.
- Networked: the teams across the country should all be talking to each other. One of the most brilliant but little-talked-about innovations of the central government digital transformation movement was the cross-government Slack instance. All digital professions in the civil service across the country could instantaneously reach tens of thousands of other experts. A question like “does anyone have experience of translating services into Welsh” would attract multiple offers of help within seconds. Building on the curated communities that already exist like Digital Health Networks need to be turbocharged.
That’s my view at least. I am sure others will have alternatives and I’d really love to hear them.
First published on Medium on 10 December 2020.