What is an Integrated Care System?

NHS Integrated Care Systems – also known as ICSs – are a 2019 NHS initiative that bring together the work of primary and community healthcare stakeholders, representing an evolution from Sustainability and Transformation Partnerships (STPs) towards even closer collaboration.

The theory is that joining up organisations provides more joined-up care for patients; in an NHS Integrated Care System, NHS organisations, local councils, and other partners take collective responsibility for managing resources, meeting NHS standards, and improving the health of the local population. Staff from teams including social care, health care, physical health, and mental health, come together to support patients.

How do Integrated Care Systems work?

The NHS Integrated Care Systems model relies on meaningful integration of organisational systems and staff. However, many of the involved organisations have been working in silos for many years, with very little communication, even when the same patient was receiving care from multiple services. Moving successfully towards further integration requires a significant shift in both mindset and operations.

A new opportunity

The NHS long-term plan set an ambition for all areas of England to be covered by an Integrated Care System by April 2021, but by December 2020, there were 29 ICSs covering only around 60 per cent of the population - some way off the target. Although progress has been slow, it does mean that there is an opportunity for new ICSs to ensure best practice is baked in from the offset. We believe that to create a truly integrated care system, organisations must take advantage of digital technologies that allow information-sharing, collaboration, and flexibility across organisational boundaries.

Here, we discuss three key areas and explore how Integrated Care Systems of the future can practically achieve system integration, with minimal disruption.

Beyond shared care records

The obvious place to start with creating a closer collaboration is consolidating the various different systems on which patient information is stored. GPs, hospitals, community teams, and councils all use different systems to store information about patients, which can make sharing and collaborating a huge challenge. Bringing everything onto one system would make this much easier.

Clinical collaboration and planning

However, this is a huge undertaking and although shared patient records would be a strong start, new ICSs should go much further and also implement systems that support clinical collaboration and planning, and more efficient, safer caseload management. Existing electronic health record systems (EHRs) are often not optimised for workflow management, and rarely for mobile use, so teams still spend time in physical meetings, writing notes by hand, on phone calls, sending emails, or exchanging instant messages to coordinate care tasks with one another. The introduction of a digital task management solution that integrates with the EHR would help bridge the communications gaps that can exist between teams, even when they are using a shared patient record system.

Connect partners caring for the same patient

A digital task or caseload management solution of this type would 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 in real-time. Trusts such as Somerset Foundation Trust are already putting such tools to good use within care settings, and in the case of London North West University Healthcare Trust, are utilising it to realise the objective of more integrated and coordinated care in the community.

Digital transfers of care

Proper transfers of care are already a vital part of an efficient health system, contributing to appropriate use of resources, timely discharges back into the community, and better patient flow within hospitals. However, current mechanisms to transfer a patient’s care from one service or organisation to another often involve reams of paperwork, phone calls with GPs, social services and other care providers, and multidisciplinary meetings across organisations; this can result in potentially long delays and bed-blocking.

Begin with hospital discharge planning and task management

This is another area of concern for Integrated Care Systems that would benefit from a digital solution, and a task and caseload management system similar to the one described above would make transfers of care across teams and organisations seamless. Integrating transfers of care across organisations could even begin with hospital discharge planning.

Connect hospital, primary, community care providers

If a patient was under the care of an acute hospital team using a digital task management platform that was integrated with the EHR, a history of all tasks, transfers, and care plans would be available in real-time to all hospital staff caring for the patient.

Imagine that the community care team for the area and the patient’s GP were also using the same system. When the patient was ready for discharge to their care, instead of having to re-log all details into a different system, verbally share information about the patient, and enter handwritten or typed forms into the system, all information would be digitally transferred, in the correct format, at the touch of a button. At the moment, discharge summaries from hospital can take several days to arrive, so healthcare professionals don’t always have immediate access to up-to-date information.

A digital task management solution like the one described above would reduce the need for long handover meetings, paperwork, and letter-writing to complete what should be a simple process.

Effective data analytics in integrated care systems

One of the key elements of Integrated Care Systems outlined by NHS England is that they are data-driven, ensuring they appropriately organise care around the needs of the population.

Collect and use task management data

Utilising the data collected from a digital task management tool like Infinity could be used to analyse and understand demand and how it matches or doesn’t match with resource allocation and staff skill mix. In this way, rotas and recruitment could be optimised and tailored to the health needs of the local population, making for more efficient and effective services.

Identify and respond to trends

This kind of data could be analysed in multiple ways to understand geographical and temporal trends in the needs of local patients, for example helping to identify if a particular area has patients with similar health problems. Over time, the data may also be used to not only respond to current trends, but predict future ones. Understanding these would enable Integrated Care Systems to respond in a way that is flexible and appropriate, and uses resources in the most efficient way possible.

Integrated Care Systems fit for the future

There’s no doubt that meaningful and sustainable integration of services to create ICSs will need appropriate digital tools that connect staff and enhance existing ways of working.

However, underpinning this ambition is the need for all organisations in an Integrated Care System to have basic digital infrastructure in place, and for all staff to be digitally proficient and confident. Access to adequate Wi-Fi, mobile internet-enabled devices, and digital literacy support are essential to create services that support NHS sustainability and are fit for the future. If the NHS does one thing towards ICSs tomorrow, it needs to be this.