Digital leadership in integrated care boards (ICBs) continues to be a careful balancing act, with efforts to maintain and improve systems proceeding on parallel tracks, NHS and other transformation leaders agreed in a session on the final day of the NHS Confederation Expo conference in Manchester. 

The panel of three trust leaders and strategists agreed that boards need to hold their nerve and find ways of carving out space for change while avoiding political pressure from the centre.

This entails having a clear strategy, keeping transformation simple and practical, and making it a job for the whole organisation. It also requires that frontline staff feel empowered to shape change. 

Digital improvement “should be seen as not an add-on, but a solution,” said Mandy Nagra, designate ICB/ICS executive chief delivery officer for NHS Birmingham and Solihull. She added that organisations need to make sure they get the basics right, something that can be trickiest for those organisations with the least breathing space to implement change.

The process of upgrading digital maturity continues to be a challenging one, said Emma McGowan, a director of design and transformation at Surrey County Council, and a former director of digital in the London Borough of Hackney. 

“We’ve looked at what we have and are trying to tweak around the edges and there is going to be a cliff edge,” she said. “In order to do disruption in a way that doesn’t destabilise delivery, you need to be using parallel processes.” 

McGowan also noted that while some ICSs have the headspace and funding to invest in “thinking” type roles to envision longer-term digital strategy, others are currently stuck trying to keep basic services on track. 

“You can’t put in a new kitchen when the house is on fire,” she added. “You can do more exciting things later.” 

Final innovative ways of anticipating pressures 

Shane Devlin, chief executive of the Bristol, North Somerset and South Gloucestershire Integrated Care Board (BNSSG ICB), agreed that “strategy is not always about the whiz bang thing,” and that while it is important to have a whole ICS strategy, each partner needs to have their own strategy as well.   

He added that BNSSG ICB is continuing to develop its Care Traffic Control Centre with the aim of improving performance and patient flow and making services more efficient.

The centre, which is linked with the ICB’s shared data environment (SDE), can do some detailed public health planning, he said, but doesn’t have an answer for “what if?” 

Devlin said: “I want to have a single managed system that needs to be able to see the flow of traffic whether in GP surgeries or care homes. Using modelled flows and learning from data, the system could ultimately predict potential logjams.”

Developers are hoping to use AI to build a model of what the system might look like in 24 to 48 hours and how an especially busy GP surgery, for example, might affect other parts of the system. 

“You wouldn’t get on a plane if air traffic control wasn’t working,” Devlin said. “It makes sense to have some sort of traffic system and see what it tells us.”

A well-developed program could also enable boards to determine how spending additional money in one service might affect the rest of the system, he added. 

Devlin and the other panellists also agreed it is unrealistic to expect every member of an organisation to have the time to take a key role in all of the changes it hopes to push through.

“If we can get people involved in four big things, hopefully it can generate a multiplier effect,” he said. 

NHS Confederation, along with NHS Providers, have set out to help digitisation within ICSs by launching a new support programme last year.