NHS Advisory Board - Integrated Care Systems
APRIL 1, 2021 saw another standout moment for healthcare, as the NHS in England was formally split into 42 Integrated Care Systems. Each has been tasked with bringing health and social care services together to shape services that better serve the needs of local populations.
VerseOne, in partnership with Blue Lozenge, hosted the first in a series of roundtable events attended by patients and executives to explore the fact that each ICS must deliver a coordinated digital offer, and discuss ‘what good looks like in the eyes of citizens’.
Patient Partner Sara Turle is well qualified to speak about the importance of digital healthcare. For the past seven years, she has worked with Barking, Havering and Redbridge Hospitals NHS Trust to embed quality improvement. She’s also an 11-year survivor of cancer.
Sara began the discussion by highlighting why digital services really matter to patients: “My greatest concern and greatest insight, speaking as a layperson, is to never, ever lose sight of why people are accessing health services. We’re not accessing them to place an order, we’re not trying to access because we’re doing something fun, we’re accessing [them] because we’re unwell, we’ve got a concern, we’ve got an issue.
“People will be ill, worried, mentally overloaded, and we have to keep this at the forefront of our minds when designing and putting [digital] support in place.”
Sara’s point is backed up by key evidence. Despite claims that Covid-19 has accelerated digital healthcare, the 2021 GP Survey revealed that less than one in five patients had chosen to use online services to book an appointment.
Our conversation sought to explore five key questions which must be answered if ICSs are to change this and deliver a new, patient-led digital landscape which improves outcomes, tackles inequalities and strengthens communities.
- When thinking about your ICS, what insight do you think is needed about your local population to provide digital solutions?
Our panel echoed Sara’s [Change to: ‘the patient representative’s comments…’ if we can’t ref Sara] comments, and agreed ICS digital platforms must be shaped by the populations they serve.
One panel member said: “Covid has solved a lot of digital problems, but it’s created new ones that we didn’t ever anticipate. What I have learnt though is that there’s a whole sub-layer of things you need to know about your community that I never envisaged.”
In order to deliver effective and enduring change for communities, the panel member added ICS digital teams must “keep digging deeper” to understand how local cultures work and discover insights which will “bring them on this journey with us”.
Several speakers highlighted the fact that Covid had accelerated digital transformation within health and care, but also intensified digital inequality and exclusion among vulnerable communities.
In response, it was agreed that ICSs must now work with populations to mine insight which will help them understand barriers to access, and shape the “co-design and production” of digital platforms.
“The huge irony is normally the insight and engagement we have is from the population that has [digital] access and we have regular contact with,” one speaker said. “I think we need to shift our focus to the people we don’t hear from and find the barriers there.”
However, several participants said digital healthcare was not the answer for all patients, and risked dismantling one of the founding principles of the NHS – equal access for all.
“The risk is we put too much emphasis on it because we think everyone has an iPhone nowadays. We need to make sure we know the population that don’t have an iPhone in their pocket and we have solutions for them, as well as making it easier for the people who do have,” said one speaker.
- What do citizens want from health and care digital channels? Do we think that’s different from what they may need?
Technology is continually opening up new possibilities for prevention, care and treatment. But as the NHS Long Term Plan highlights, it has yet to enable the wholesale transformation of clinical outcomes and services patients have a right to expect.
Sara Turle [Change to: ‘Our Patient Partner’ if necessary] said some of the key themes which must be addressed if ICS digital channels are to deliver joined-up care included accessibility, reliability, and coordinated services which “talk to each other”.
One panel member added patients wanted to be reassured by digital health services, too, but trust was proving difficult to establish virtually.
“We are certainly seeing people presenting at our paediatric A&E after having a digital consultation with a GP who just don’t feel reassured. They want that physical connection.
“And I think citizens want health and care digital channels to be better. That means being simple, clear and easy-to-access because, let’s be honest, they’re probably not at the minute.”
Panel members also agreed ICSs faced a significant challenge to make yet another healthcare reorganisation really matter to service users.
“It’s how we are able to tell the story about it all coming together while making it real for them,” one speaker said. “I think that’s going to be quite a challenge.”
“I just wonder whether citizens even know or care about ICSs. All they want is joined-up care,” said another.
- How will teams work together to audit, map and understand their current digital landscape?
Evidence has shown that most people’s experiences of health and care services are collected by individual providers. In simple terms, we know about patients’ experience of individual services, but not whether they are able to work well together. The challenge for ICSs is to prove they can.
However, panel members said ICSs should not try to be all things to all patients.
“ICSs need to be brave and say if there is a particular behaviour from the public that we can’t change and we’ve been trying to do so for 20 years, then let’s not try to come up with a digital solution for it,” a participant said.
A colleague from the communications sector added ICSs also faced practical challenges, as more joined-up channels would mean “more people fighting for that space”. “I think that tension around being one big organisation when there are so many diverse audiences within each trust anyway is going to be a real challenge and a difficult one to resolve.”
- How will you go about developing a digital strategy for your ICS area?
The recently-released ICS Design Framework states each partnership will be responsible for agreeing a strategy for improving health care, social care and public health across its whole population, using the best insights from data available.
But one panel member stressed that “balance” was required: “Yes, we’ll put some digital things in place, but they have also got to be supported by all the other engagement work that we do with communities – face-to-face or with community groups and everything else.”
However, they added using digital would enable partnerships to “widen their reach”.
One panel member went a step further by suggesting successful digital channels could be the “bedrock” for better community engagement.
“If we can get all our digital channels right, then we can get all the personal contact correct and really reach out to communities.”
- If we are looking back in 12 months’ time, how do we know we’ve succeeded?
Patient Partner Sara Turle added success, for her [Change to: ‘Our Patient Partner added success would be…’ if necessary], would be achieved when barriers to digital inclusion were removed and “everyone had a seat at the table”.
“I think for me, it’s also going to be very much about the staff on the shop floor feeling that they have the time, capacity and skills to implement and embed the technology. That, to me, is a huge success point. If they don’t do that it’s going to impact on patients.”
Concluding the event, moderator Rachel Royall, Founder and Managing Director of Blue Lozenge, said in order to “put patients first and change and transform, ICSs need to be brave in the comms and digital solutions they develop. Successful solutions will only be delivered when they are co-designed with the people we need to serve”.
The digitisation of integrated care systems must take place at a pace at which all of society – including the least digitally literate and those who struggle to gain access – can keep up with.