Embedding digital in the ICS landscape

Mike Farrar has absolutely no doubt that data and digital more generally are vital to delivering better health and care services – but questions whether organisational cultures are keeping up with the technological possibilities. 

There are, he says, huge opportunities with the development of integrated care systems, and a move towards greater collaboration, but the question remains of how ready services – and the people who work in them – are ready to do that. 

“The evidence is that if you find ways to collaborate rather than compete you can get better value,” he says. “When you look across the world, indeed at the strategies that integrated care systems have employed, yes they’re doing prevention, yes, they’re trying to do proactive primary care, integrated community services, co-ordinated urgent care and better managed acute care. 

“But actually, what drives the systems that work well is the use of data to target resources to those people at greatest need – which is a big challenge for us culturally.” It’s also important to use the opportunities brought by digital to engage citizens in their own health, and their healthcare, he adds. 

Mr Farrar, a former head of the NHS Confederation, and now a management consultant, who returned to the NHS during the pandemic to offer free support to King’s College Hospital as acting deputy CEO, sees ICSs as offering tremendous opportunities.

But he adds: “We can do all the integration we need and want to do in terms of complying with a white paper. But unless we culturally understand that to deliver the benefits of that, we need to use data and digital engagement in a different way, then actually that may well fail.” 

Held in June in association with Cisco, this HSJ webinar grappled with some of the challenges facing England’s integrated care systems as they continue to develop across the country. Jas Cartwright is very much at the frontline of this development. As digital innovation lead both for Worcestershire Hospitals Acute Trust, and for the Herefordshire and Worcestershire ICS, she is sharply aware of the issue facing the new bodies and the organisations that make them up. 

“We all know the challenges we’ve had over the last 14 months or so, and coming out of the pandemic, we’ll have two major issues from a trust perspective. We’ve got tired staff, our workforce is exhausted, so how do we support their wellbeing? Digital can play into that. But also from a reset and recovery perspective, we’ve got huge waiting lists within organisations. So now it’s really about how do we make sure that some of the things that covid helped us to embed and introduce, such as virtual working, stay in play?” 

Ensuring that patients aren’t digitally excluded is important, but it’s also important to make sure that staff are supported in developing their digital skills. “It’s about how we recognise that at an ICS level,” she says. “Because some of that can’t be done from a provider perspective, it needs to be joined up with the ICS.” 

Key priorities

It’s key to understand the key priorities that need to be funded, accelerated and embedded across the system, as well as the main challenges around demographics, for example, Ms Cartwright adds. “It’s about how do we use data to drive some of those transformational models of care,” she says. “The ICS is really key to bringing together those stakeholders to have those clinical conversations, for example, about how do we use those digital tools we’ve now got? It all challenges us to think differently.” 

‘If you’re going to be responsible for a system as well as an organisation, you’re going to have to have the data’

Moving forward as an ICS is challenging, adds Ms Cartwright, not least because different organisations are at varying stages of digital maturity. “From a digital perspective, you’ve almost got to be at a level playing field in terms of being able to share and leverage that data, and if there’s one provider organisation that’s at a different level of maturity, it becomes a different conversation.” 

Declan Hadley, healthcare development lead for the UK and Ireland for Cisco, worked for the NHS for 30 years before joining Cisco in January. Most recently he was the digital lead for Lancashire & South Cumbria ICS. He is a strong advocate of allowing all stakeholders the time and space to build relationships and think about the opportunities that integrated care could deliver. But he is also keen to encourage people to get the right building blocks in place.

“There are some rather mundane tasks that need to happen to establish an infrastructure that supports integrated care in the neighbourhood, at place and at system level. You need to get the basics right around your [data] and your network infrastructure.

“You need to make sure, for example, that if we’re aspiring to place-based care, and to some form of collaboration or mutual aid across organisations to tackle the backlog of care, that clinicians and the operational staff can work seamlessly, regardless of the location they’re at. That includes a shared record and shared data in various guises. But importantly, it’s things like access control to buildings, the wifi infrastructure, and all those things, the ‘gotchas’ that if you don’t think about at the start, you’re going to run into problems.” 

The panellists agreed that while there was progress across the country, there’s much more to be done, not least in ensuring buy-in from clinicians and senior management as well as from patients and citizens. 

“From my experience, and from what I’ve seen now at a country level, we’re not at a bad place,” says Mr Hadley. 

“There’s lots of great examples where they’re starting to think about how they work together at a system level. And from a technology point of view, it’s not necessarily rip out and replace. There are ways that we can link and connect organisations together, even in their legacy states, that will allow, for example, a clinician to move between one hospital and another, into a primary care site, or even into the council.” 

The panellists discussed a variety of issues including use of data from across the board – including borough councils – to help determine need and plan services. They also discussed the importance of building confidence in clinicians and the public, and getting the right funding for the right things. 

Again, sharing data is key, says Mr Farrar. “Incredibly few boards see anything other than data about their own organisations,” he says. “But if you’re going to be responsible for a system as well as an organisation, you’re going to have to have the data.” This, he adds, helps encourage people to think collectively. 

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