Do we have the digital capabilities for mandatory ICSs across NHS England?
Lucy Grieve
The Health and Care Bill came to the floor of parliament in July. If successful, all 223 NHS England Trusts will be required to establish Integrated Care Systems (ICSs) - making this a crucial component of the most ambitious NHS-related policy proposal of the 21st century.
Lucy Grieve discusses how changes suggested in the bill would see a knitting together of local government, individual NHS trusts, and social care providers with the aim of created an integrated care framework that favours shared responsibility of health and care providers following years of patchwork care in the community.
Why integrate care?
The new legislation hopes to remove the bureaucratic ‘red tape’ from the system and streamline the procurement process. It will also see a swing towards the everyday use of digital healthcare tools, like task management platforms and clinical apps, to promote communication across the ICS following years of silo-working for many of the partners.
The proposals of the bill are supported by changing public attitudes to digital healthcare, like telemedicine. A pre-COVID-19 study showed that 63 percent of the UK is already using or considering the use of a digital health service to speak to their doctors. The rapid introduction of telemedical consultations during the pandemic meant that by the beginning of 2021, a quarter of UK patients had used telemedicine in the past year.
But this just scratches the surface. Not only are patients getting on board with digital healthcare at the point of delivery, digital tools are also helping to support staff working in community-based care for example by coordinating tasks. This allows them to see real-time updates about patients’ care wherever they are and optimises efficiency for sharing information across organisations.
This sounds good, and it is the future. But is it too ambitious for the current digital capabilities of NHS Trusts?
Where we are at, digitally
In 2018, then-Health-Secretary, Matt Hancock, stated that NHS chiefs should ‘be asking themselves serious questions’ if they did not yet have a Chief Information Officer (CIO) on their board.
Hancock believed that CIOs were an integral part to achieving the NHS’s digital ambitions, but at the start of 2021 almost 80 percent of trusts were without a CIO on their board.
This doesn’t necessarily mean that trusts are behind the curve of digitisation, but it does mean that there is a lack of top-level championing for digital solutions. This, in part, could explain why there are only 42 ICSs across England right now.
Where we need to be
ICSs across the country will be required to have smart data foundations in place by April 2022. Whilst there’s no definitive blue print for the creation of an ICS, each trust must move towards introducing an electronic health record (EHR), plus other tools to support their everyday running.
Utilising digital solutions that facilitate the meshing together of services across the community, creating clinical coordination and sharing real-time updates should be the focus of trusts now as April 2022 looms.
Trusts like London North West University Healthcare Trust (LNWH) have already started to support more integrated and coordinated care in the community, through their use of a digital task or caseload management solution which enable partners caring for the same patient to see and edit care plans, share and update tasks, and keep track of what has been done for each patient and when – all with real-time visibility. LNWH is not only leading the way in creating a gold standard for ICS partnership working, they are also showing how trusts can undergo digital transformation by adopting simple solutions.
How close are we?
Perhaps the reason as to why we haven’t implemented more ICSs since their inception in the 2012 Health and Social Care Act goes beyond a dearth of CIOs on the board of trusts.
Creating quality, safe Integrated Care Systems requires significant investment. ICS implementation comes against a backdrop of the COVID-19 crisis where billion-pound attempts are being made to tackle the backlog and restart elective services. Digital literacy, too, requires more streamlined funding if goals are to be met - with significant parts of England remaining ‘digitally excluded’ and staff ‘being hindered’ by technological changes. Further investment must be made into upgrading digital competence of staff and physical infrastructure.
Parliament might be ready to implement ICSs across the UK, but the healthcare landscape still needs time to make the appropriate arrangements and this will take time. To integrate care on such a large scale, it’s up to the government and NHS England to ensure that trusts have the support they need to call on digital resources that will help to connect staff and boost efficiency across the sector.
About the author
Lucy is a key member of the Infinity Health communications team with a passion for health policy.
She joined Infinity Health after spending two years working for a Member of the Scottish Parliament, where she supported the production of high-quality external communications with press, constituents, and the general public.
Whilst Lucy gained a deep understanding of the workings of local and central government, her move to Infinity Health has facilitated further learning about how healthcare is managed, as well as the ways that start-ups can go far in supporting health equity.
She’s currently studying for her undergraduate degree in Social Anthropology and Social Policy at the University of Edinburgh and hopes to go on to complete a master’s in health policy.
