Special Report: Integrated Care

Integrated care systems (ICSs) are likely to acquire statutory footing at some point in 2022. Maja Dragovic looks at how big a role digital will play in establishing connected care within ICSs.

According to the NHS, integrated care is about giving people joined up support which spans local councils, the NHS, and other partners.

This way of thinking has been embodied with the creation of Integrated Care Systems (ICSs) – new partnerships between the organisations that meet health and care needs across an area, which aim to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.

The 2019 NHS Long Term Plan confirmed that all parts of England would be served by an ICS from and NHS England and NHS Improvement has asked the Government and Parliament to establish ICSs in law and to remove legal barriers to integrated care for patients and communities.

The target date for ICSs to have statutory footing with originally pencilled in for April 2022 but in January 2022, it was confirmed that target date had been pushed back to 1 July 2022 in order to give enough time for the remaining parliamentary stages of the Health and Care Bill, which is currently being debated in the House of Lords.

When it comes to integrated care, Cerner’s Justine Patterson believes digital is a key enabler. Without it, she says, delivering better and more proactive joined up and seamless care for their populations will be nigh impossible.

“The role of digital technology is really to help the ICS deliver on all their fundamental purposes, which is improving population health, tackling unequal outcomes and access, enhancing productivity and value for money, and basically helping the NHS support that broader social and economic development,” adds the senior health network strategy executive.

Digitalising care provision within an ICS to provide integrated care is not an easy task, however. Each ICS within its borders has varied digital maturity in different settings and where to start is a big question.

Patterson believes that the What Good Looks Like framework is a good starting point as, she argues, it will help assess the ICS’s digital maturity. The framework, which was published in August 2021, outlines how NHS organisation should be driving digital transformation and what success looks like.

“(The framework) will help identify where the (ICS’s) needs are, and what they need to develop,” Patterson says.
“And that helps them form their digital and data strategy, which they can then work from.”

What Good Looks Like, will also help identify providers that are still working with paper records that may be a priority for the ICS, she adds.

Quick wins

Another starting point, according to the Nathan Gasco, general manager at Civica, would be for ICSs to focus on digital quick wins. Gasco says it is crucial to build on the small areas of existing successes that will show benefits in incremental steps to ensure long-term adoption.

“There will already be in every single ICS small areas of success, whether that be in MS, whether it be in cancer, wherever you’re going to have some sort of successes already there,” he says.

“Essentially, just build on (those successes), utilise existing collaborations and build upon them.”

Patterson agrees that digitalisation should be kept simple at the start. She suggests another step would be to connect care settings by providing access to the electronic shared care record (Health Information Exchange) via the web. This removes the necessity for each stakeholder to have its own EPR in place but enables them to view relevant patient information.

“You want to make sure that your frontline staff, working across the system, have access to a real-time shared care record at the point of care to support safe and effective decision making,” she says.

“And that includes staff right across the system: including primary care, community, pharmacies, dental and optometry services, secondary care providers, mental health providers, community, domicilary and nursing care, residential care, tertiary specialists, local authority services, and VCSE.”

Rich data sets

As ICS make progress on their digital journey, more care settings will be brought it, meaning the data on the patient will become richer.

“Systems will recognise that they’re only as strong as their weakest link,” Patterson points out.

“You want social care data coming into the mix with the rest of health data. And in some places, social care  have got minimal electronic records, for example.

“You won’t be able to see that data and you’re going to want to invest in social care, and personal record that’s electronic. You can bring that data together with the rest of the system and actually end up with a richer data set.

“That insight then helps you decide what your interventions are going to be, how you should align your incentives to actually improve your population outcomes, which is really what ICSs need to be doing.”

Work with what you have

Data is expected to play a huge role in ICSs and according to Gasco, bringing in more data is just a part of the jigsaw puzzle. For data to be used as information, it needs to be structured, he adds.

However, Patterson says that ICSs don’t need to wait for the data quality to be perfect, but work with what they already have.

“If you wait until it’s perfect, you’ll always be waiting,” argues Patterson.

“You need to work with what you have and have that feedback loop back to the source data systems so they can improve the quality of the data that they’re capturing. That’s much easier to do when the end users are using the outputs of the collective data set.

“When they can use that intelligence for case finding, finding people that are at risk of developing hypertension for example, and they can do proactive outreach, once they can see how that data is being used at scale, it incentivises them more to capture the right data in the first place.”

Challenges ahead

The sheer amount of different care settings at different levels of digital maturity mean there will be many challenges ahead to achieve integrated care with digital. One that stands out, says Gasco, is governance, precisely due to having multiple stakeholders, which sit across trusts that make up the ICS.

The other challenge, adds Gasco, is varying IT strategies which could conflict against the ICS strategy.

“The problem that they’ve got as well is that budgets are typically set at a local level,” he adds.

“And when you’ve got conflicting priorities, if you’ve not got strong leadership and strong governance that sits across the ICS to to guide this through, you can see a lot of blockers. “

Not an IT project

One of the biggest challenges for ICSs could be how the organisation itself see digitalisation. Both Patterson and Gasco emphasise that digitalisation is not an IT project but a change management project.

“What we’ve seen as one of the biggest challenges is that people see digital technology programmes as being IT implementation, where really they’re change management or transformation programmes,” explains Patterson.

“They often get procured and driven by directors of IT and they’re seen as an implementing kit or software, rather than a change management programme or transformation programme.

“If you really want to get the benefits out of it people need to change what they’re doing, because just putting in some new software doesn’t change anything,.

Gasco agrees, adding that “change management in this type of programme of work is key and having a clinical adoption and clinical sponsor and someone who can articulate at clinical level what benefits this will drive and what it will mean on a day to day level”.

Patterson concludes that adequate resourcing for project teams needs to be ensured for the programmes to be implemented successfully.

“It takes time. People think most of the funding just goes on software or the kit, rather than actually on the people and the behaviour change that you want to happen.”