ICSs must put the basics in place to achieve digital transformation

For Heather Tierney-Moore, one of the digital challenges facing the NHS at the moment is encouraging decision-makers to see beyond the shiny and new. As integrated care systems take shape across England, the former CEO warns that it’s vital to get the basics in place in order to realise the potential of all that digital has to offer.

“It’s very easy to be distracted by the new,” she says. “The interesting conundrum in terms of people thinking about technology and digital is that sometimes people are buying cherries to put on cakes that haven’t been baked. They are interested in that shiny cherry – it might be some sort of self-care app that people can use – but these apps won’t be anything like as powerful as when you’ve got all the data to understand how people are behaving so that you can support self-care and reach the most vulnerable.”

The government has made it clear that it believes digital to be key to its transformation agenda, not least in the move to integrated care. This, says health and social care secretary Matt Hancock, has become only more evident during the pandemic, with more people than ever before turning to digital to meet their health and care needs. In a speech in March, he urged health services to get on with digitisation – and that included getting the basics – such as infrastructure and connectivity – in place.

The challenges will be greater for integrated care systems, which will have to meet the same changing demands as individual organisations – such as treating patients closer to home – while working together across larger geographies and organisational boundaries. This brings huge opportunities – such as harnessing the power of population health data to benefit whole communities – but also challenges, especially for organisations at an earlier stage in the digital journey.

For Ms Tierney-Moore, who works as a consultant as well as holding a portfolio of other roles, including as a non-executive director with NHS Supply Chain, the priority for ICSs should be to have a system-wide digital maturity roadmap that everyone is working towards. “Those that have strong digital programmes that are really aligned to the clinical transformation and the health outcomes that the system’s trying to deliver will be in the best position to make progress.”

Infrastructure, knowing what legacy systems or “technical debt” you are dealing with, connectivity and security are all vital building blocks for digitally mature systems

Ensuring the basics are in place and working well is essential. Infrastructure, knowing what legacy systems or “technical debt” you are dealing with, connectivity and security are all vital building blocks for digitally mature systems.

Jas Cartwright, head of digital innovation strategy with Worcestershire Acute Hospitals Trust and digital innovation lead for Herefordshire and Worcestershire Sustainability and Transformation Partnership, is also an advocate of making sure the digital “cake” is properly made.

“Firstly, it’s about making sure that the system’s joined up, so that we’re all at the same level of sharing information,” she says. “It’s about moving away from paper processes, having electronic prescribing, electronic observations, electronic assessments, and being able to share that data across the system. These are the basic building blocks you need to have in place, because that enables you to build up the next layer about, actually, how do you then change your models of care to address all the demographic challenges that we’ve got in healthcare? And how can digital help us to recruit and retain staff?”

Issues such as connectivity will only become more pressing working across the ICS, says Ms Cartwright, and data security and governance are also priorities.

Declan Hadley, who was digital lead for the Lancashire and South Cumbria ICS before joining Cisco as healthcare development lead for UK and Ireland in April of this year, says it’s important to empower and enable teams to work seamlessly wherever they are – at community or neighbourhood level, as well as in hospitals. Technology can help, but only if the infrastructure is right.

Genuinely actionable data is also key. “We have to secure and orchestrate data – orchestrate meaning to put it in a logical order that can be used for all sorts of different things,” he says. “How do we get access to data that we need to really understand the populations that we serve? A lot of the data that really draws insights isn’t necessarily inside health – it’s those wider determinants data that help us to determine unmet need. If you look at the data for health all you see is the people using the system – what about the people who aren’t using it? How do we make sure we’ve not left people behind?”

Ms Tierney-Moore is also an advocate of a population health management approach. “What the pandemic has demonstrated very clearly is the importance of understanding population data and the value of predictive analysis,” she says.

“It’s brought home the challenges of keeping a population safe and well, rather than thinking about individual patients who are accessing services through a provider. You’re only going to be able to do that by having really mature approaches across the whole system that are broader than just focusing in on health and health services. But you’ve got to have the infrastructure and the data systems in place before you can do the clever stuff.”

A free HSJ webinar run in association with Cisco on June 9, will explore key questions about the digital priorities for integrated care systems. Register here to watch