The transition to Integrated Care Systems has been in discussion for several years and last week the Government published the long-awaited white paper, ‘Integration and Innovation: working together to improve health and social care for all’, outlining the path toward ICSs being formalised.
Working together to integrate care
The white paper states that, ‘At the heart of the changes being taken forward by the NHS and its partners, and at the heart of our legislative proposals, is the goal of joined up care for everyone in England’.
This is a laudable and important aim but for it to be successful, it will need functional and consistent collaboration. The paper identifies health and care services, local government, NHS bodies, ‘and others’ as the key partners in this collaboration. We believe it is crucial that the ‘others’ include digital leaders – both those working within ICSs and those providing digital services. Time and time and again, it has been demonstrated how important digital leadership is for innovation and driving transformation. This can only happen through collaboration between NHS digital leaders and those from the private sector.
The UK still has a way to go in achieving true digital transformation, especially looking to the significant shifts that ICSs will require. The COVID-19 pandemic has catalysed the adoption of various digital technologies, but this has not been uniform, and often taking place at discrete points of the patient pathway. For truly integrated care, patients should be able to access the varying levels of care they need from different providers and areas of the system through a single, uniform journey – using one platform that connects patients and healthcare providers and ensures that data and information flow seamlessly between them.
The role of digital service providers should be to support ICSs and the healthcare providers within them to deliver care more effectively, enabling efficiencies that allow more time for more urgent clinical needs. Healthcare providers are the healthcare experts, and technology providers must support rather than hinder them.
The white paper also sets out to reduce bureaucracy, with the goal of removing the barriers that hinder organisations from working together. This is to be driven by a change in procurement processes which removes the requirement for putting contracts out to tender. If this works as intended, ICSs should have greater flexibility to procure the services most appropriate at their local level. ’Bureaucracy busting’ would go a long way in enabling providers to identify and implement the support and services they need, without having to jump through hoops to get there. This has huge potential gains when it comes to implementing new technologies, offering more time to thoughtfully design local solutions and ensure those on the ground have the support to implement them. We must not, however, revert to non-competitive, centralised procurement, which was utilised during the initial phase of the pandemic. Change will of course take time, but the quicker we can get started, the quicker we can get there.
Improving accountability and enhancing public confidence
This paper comes at a time where the NHS continues to face the most challenging period in its history. Health and social care staff have done an incredible job throughout this pandemic. However, with the system having been described on several occasions as ‘on its knees’, the public must be assured that services will be there when they need them. Indeed, ensuring people engage early in their care will improve health outcomes as well as save money.
Making video calls a familiar and regular way for patients to talk to clinicians is a good thing but we are only scratching the surface of the potential for digital platforms to revolutionise how care is provided. It’s critical that each individual’s experience of these new digital channels is positive and reliable. This means consistently high levels of up-time, patient-initiated appointments and white-labelled solutions that ensure a seamless experience between NHS providers and any digital platform.
We know that not all populations are being reached by digital services at this point. In our recent report, we found that groups such as those over 50 under-utilised online consultations in the first national lockdown compared to those who are younger. BAME communities also continue to experience a disproportionate impact of the pandemic and reports have shown a lack of trust in the health and social care systems as a result of historic and ongoing mistreatment and lack of meaningful engagement. Accountability must be to all, and we must ensure that digital services are appropriate for, available to, and trusted by all if we are to reach a point of full digital transformation.
Additional measures around public health, social care, quality and safety
Finally, the white paper touches on the need to bring forward additional measures to support social care and public health. In order to deliver truly integrated care and to reap the population health benefits that ICSs can have in the long term, social care cannot be left out of the equation. Digital transformation is not just about the front door and the consultation room; it’s about supporting the entire workforce to benefit and for patients to be supported as they move through the entirety of their care pathways.
The changes outlined in the white paper have been described as an ‘overhaul’ of health and social care. With this laying out the blueprint for what’s to come, we must ensure there is a clear path for digital service provision as well. If done right, it will play a critical role in offering truly integrated care.