How ICSs can harness the power of tech

Lenin famously said: “There are decades where nothing happens, and there are weeks where decades happen.” He may have been speaking in the context of Europe sliding towards revolution but the NHS has experienced its own revolution in the use of technology over the last few months, as the covid pandemic has forced it to swiftly reshape both services and how it interacts with patients.

Nowhere has that revolution been more acute than in how the NHS uses technology. Within weeks GP appointments and hospital outpatient appointments were converted to video, and many NHS managers moved meetings to Microsoft teams.

But as the peak of the pandemic has passed the question is now which of these initiatives will endure and how can integrated care systems and sustainability and transformation partnerships lever them to deliver efficiencies and improve care for patients?

An HSJ webinar, in association with PA Consulting, looked at these key questions. Cindy Fedell, the chief digital and information officer for the West Yorkshire and Harrogate Health and Care Partnership, outlined the “huge onslaught” IT teams had faced as the NHS tilted towards using technology in a short timeframe. “Most teams ran for seven days a week for weeks on end,” she said.

There was a great opportunity to use technology, which had been around for years, she added, and some of that might continue such as patients using technology to speak to relatives and the use of technology to monitor people at home. “That cultural shift is something we need to take hold of and make sure we don’t lose,” she said. There were potential efficiencies from using technology but there was also patient experience and safety to consider, she pointed out.

Buy in from those involved, whether patients, carers or staff, was crucial in the adoption of technology and new ways of work, said panellist Sarah Scobie, deputy research director at the Nuffield Trust. She pointed out how the pandemic had changed attitudes with those working in the NHS feeling not just that using technology was expected but that it was also the “right” thing to do.

Difficulties

The pandemic had also exposed differences in readiness between parts of the NHS – but also patient readiness, she added.

Common difficulties encountered during this time had been sharing records between service providers and how quickly practices had been able to set up with remote consultations, she added.

Indi Singh, a digital healthcare expert with PA Consulting, emphasised the importance of a holistic focus and patient-centred model, especially as patients moved between different services within an ICS. “We can’t see digital tools in isolation – otherwise you end up just creating a digital version of a paper or physical process. That’s why what we have gone through is perhaps easier than what we are going to go through,” he said.

Looking forward, he said flow would be crucial with a need to think about access to the system rather than access to an individual organisation. Not sending people into hospital and treating them elsewhere had workforce implications for primary and community care – and workforce tools for planning could be important, he added. Contact time within the hospital needed to be optimised with, for example, digital triage.

Ms Fedell said one impact of the pandemic had been that everyone now knew they could do things at pace if they wanted to, citing the Nightingale Hospitals which had been created in days.

Interoperability

Moving forward is likely to involve much more interoperability between systems to follow for the flow of data as patients moved between different settings. The pandemic had led to greater discussion about how this could happen, said Ms Fedell, while Mr Singh added that it had had a positive effect on suppliers. While interoperability is likely to still present challenges in the future, good local relationships can help to overcome issues within healthcare systems, said Ms Scobie.

Ms Fedell said the covid period had led to a lot of “what if conversations” about information sharing. “Things take a long time and everyone is very busy but if we could pick up the pace on interoperability, there is no reason why we can’t do a lot more in three months,” she said. But Mr Singh said there would need to be a focus on putting in resources to drive transformation – of which technology was only a part.

Mr Singh said there remained a lot of focus on individual pathways but there was a need to take a wider view to ensure that there was not duplication and the creation of overlapping solutions, as so many people would be in contact with multiple parts of the health system. “There will need to be a default of thinking about people with multiple conditions from the offset,” he said.

PA Consulting had been working with the West Yorkshire and Harrogate ICS and has developed a new digital maturity assessment for integrated care systems, he said, that had taken the ICS requirements from NHS England and linked them with NHSX capabilities to provide a model where ICSs could be assessed as to which stage they are at and outline their forward plan.

But he was keen to emphasise that making the best use of technology was not just about buying the right kit. “It’s not necessarily the technology, it’s the operating model, it’s the engagement approach with the public, it’s how do I have the line of sight from the strategy to the implementation plan… it’s those aspects that really make a difference,” he said: it felt as if the technology tools were there but the business change needed to happen to optimise the use of them.

Ms Scobie stressed the importance of evaluation of technology changes: a lot of changes had taken place in the last few months but it was unclear what the impact was on things such as referrals, accident and emergency attendances and prescribing. And the impact of people who were not seeking NHS care was also unknown, she said. “I think the implementation has been fantastic but we really need to be evaluating,” she continued. “One thing which will be really important coming out of the pandemic is evaluating what the impact has been – who has done well out of it, what the impact on patients has been and what some of the unintended consequences have been.”

Concerns

One concern was the risk that technology could make inequalities worse, with some patients unable or unwilling to use it. “By making some services digitally easier to access, are you opening up things which are not necessarily a priority for the NHS?” Ms Scobie asked.

Mr Singh said covid highlighted how the NHS needed to think about different cohorts of people, including those who did not have access to technology. “There’s now a collective responsibility that covid has brought to the fore… I don’t think it is an add on,” he said: ICSs would have different vulnerable groups in different places. Ms Fedell said in her ICS, Bradford city centre had many people who did not have access to the internet at home – including some who worked for her organisation. “Internet and some kind of digital tool is a basic fundamental like food, water, housing is the approach we need to take, and if that means giving that kit out, [it is] like giving out medication, food and water,” she said.

Finally, webinar chair HSJ’s senior technology correspondent Nicholas Carding asked about priorities for ICSs to think about in the next few months. Ms Fedell stressed how to bring back services safely and efficiently, Ms Scobie said there was a need to decide what the NHS wanted to bring back – and what it wanted to redesign – along with information from those affected; while Mr Singh said there was a need to support mixed models combining digital and face-to-face channels and for ICSs to look at where they were in terms of digital maturity and what was needed to help them become a thriving digitally-enabled ICS.

This webinar took place on 7 July 2020. To watch the on demand version click here.