Understand the system context

Digital is central to the development of integrated care systems (ICSs). Meaningful integrated care is not possible without the infrastructure of shared care records, interoperability and staff mobility.

NHS England and NHS Improvement have set clear expectations for ICSs on digital, including:

• A named senior responsible officer for digital on the ICS board
• Developing a shared care record to connect health and care services
• Building the digital literacy of the workforce
• Developing cross-system analytical capability to drive better decision making
• Developing a road map for citizen-centred digital channels and services

 

All of this will need to be underpinned by a system-wide digital transformation plan. These plans will need to build on the legacy of the local digital roadmaps. Work on these is already underway, as organisations look to start by agreeing shared principles.

Organisations within an ICS will be starting from different starting points in terms of their digital maturity. The goal is ubiquitous digital capabilities across the system, consolidation of services and eventually the frictionless movement of staff, all of which will accelerate the scale of innovation.

We knew how debilitating it is for patients and professionals to keep asking for the same information across our patch. This is what drove us all to the local health and care record. We knew we couldn't get everyone to change their existing systems. So instead we went for open systems and open platforms.

Louise Shepherd    Chief Executive, Alder Hey Children's NHS Foundation Trust

As these system-wide strategies evolve, trust boards will need to work with their ICS partners through a range of topics to ensure alignment:

 

• Decide what your trust should focus on and what should be done at system level
  Where does your ICS digital transformation plan overlap with your trust digital strategy?
  
  
• Decide how you will agree investment priorities across your system
  What funding is available to the system and where is investment needed most, given the very different levels of digital maturity across health and care partners? How will funding flow through the ICS to place, provider level and individual services?
  
  
• Agree collective action to ensure digital technologies redress rather than reinforce inequalities
  How are you working with your local Healthwatch and other patient/public engagement forums to ensure the needs of all people are being addressed? How does your trust and system strategy address the risk of deepening digital exclusion?
  
  
• Understand how the patient experience will change
  Will you continue to operate multiple websites, apps and patient portals, for different services provided by different organisations? Or should there be a single place to go?
  
  
• Identify opportunities for digital to break down silos between organisations
  Sharing data, communication systems, WiFi and information governance standards are critical to closer collaboration. Is your trust able to share any of its tools and capabilities, not just with other NHS organisations but also local authorities, non NHS providers and social care providers?
  
  
• Agree your interoperability priorities
  Which are the most important data flows that you should focus on first? What tools and capabilities are available within your system so you can begin to address these?
  
  
• Deliver and use the shared care record
  The purpose of these records is to ensure health and care staff have access to the right information at the point of need, improve access for patients and service users to better manage their own needs, and support the move towards whole population health.
  
  
• Agree what capability should be built at a system level
  Some ICSs are recruiting digital teams that will work across the system and enable effective joined up delivery and help avoid duplication. How are system partners pooling resources and capabilities? 
  
  
• Agree an effective governance model for cross-system working
  It is tempting when faced with system complexity to introduce more hierarchy and process as governance. This can slow you down compared to more agile forms of governance.

 

You need to back those in your system who are further behind on the agenda. Everyone needs to level up and chief executives must be honest about this. At Alder Hey we've supported the fast follower initiative and have worked constructively through the Health System Led Investment (HSLI) programme to ensure investment goes to areas that need it most in order to get organisations up to speed.

Louise Shepherd    Chief Executive, Alder Hey Children's NHS Foundation Trust

At a system level, my role as a trust chair is to ensure that we are focused on realistic solutions that are manageable. When working with other organisations, you must be disciplined about the scale of the ambition and make sure it is genuinely deliverable. The agenda can very quickly get too big. I work with other trust chairs to manage the key disagreements and broker the way forward.

Liam Coleman    Chair, Great Western Hospitals NHS Foundation Trust

Further reading:

• On the day briefing: The Department for Health and Social Care's legislative proposals for a Health and care bill
• On the day briefing: Legislating for Integrated Care Systems
• What do NHS England’s integrated care system plans mean for digital transformation?