Digital must be at the heart of integrated care

26 April 2021

Guest blog by Nick Elliott, a management consultant specialising in digital within healthcare. Nick was the first board-level CIO in the NHS and then transitioned to COO for a number of acute trusts. He also grew and then sold a small clinical software company.

As the NHS begins its transition to integrated care systems (ICSs) it’s important to take stock and consider what this might mean for digital.

There are clear potential benefits of transitioning from a system driven by commissioning and funding that incentivises players to drive independent agendas, towards one in which we are enabled and empowered to work together in the best interest of the patient.

But what will this mean for services and what is the role for digital in this emerging system? The vision portrays local systems (ICSs) that can focus on putting care around the patient rather than around the NHS’s building and organisational structures.

The opportunity to take transformation out of organisations and place it across the full gamut of skills and capabilities in a locality, NHS and social care, is an exciting one which most parties believe will truly enable new thinking and new models of delivery that better embrace and engage the patient.

Those of us operating in the digital arena see the potential to realise a vision we have worked towards for many years but we also know that the realisation of this vision will be dependent on leadership and commitment from participants.

The opportunity to combine data and technical capabilities across an entire community can only be realised if we have commitment from the top and participation from those who deliver the care and those who receive it.

Fresh perspective

The greatest challenge will be in our own ability to be objective and to collaborate with a focus on the patient and the care-givers and not on our current solutions, capabilities and organisations. We will need to look at the challenges afresh.

We are not just working under a banner of partnership that has no legal footing, we are working towards a new empowered entity that will have a very different focus from the organisations of today.

The potential to shift care and redesign pathways will be unprecedented and with that comes an enabler in digital that the NHS has not truly leveraged before.

Today’s technology is more than capable of enabling data to be accessible by caregivers, patients and carers, wherever and whenever it is needed. The available tools and our ability to develop new ones means we can realise clinical support capabilities that enable patient diagnostics and monitoring in locations that are more convenient and less stressful for the patient. With advances in AI and machine learning we can embrace technology’s help with watching over patients and identifying signals that intervention or support is needed.

Transition challenges

The challenge is how we transition from today’s infrastructures, technologies, security and governance structures to models that are less constrained and more enabling and embracing. To create wholesale change will be financially out of reach in the short-term so we need strategies that enable progress now while also keeping an eye on the long game.

We have seen many times before in health service technology a drive for short-term gains that have seriously hampered strategic capabilities.

Above all, boards need to bring digital into the boardroom and the executive suite. Digital is a strategic enabler and needs to be part of the strategic discussion, not an add-on that is passed out of the room as an afterthought. ICS leadership teams will need to embrace digital and take ownership for giving it a steer and making it part of all strategic thinking. Short-term fixes have not delivered for the NHS and the resulting failure to enable the breadth of transformation has caused boards to lose confidence in digital and hold back from making investments on the scale that is needed.

Leaders must gain the knowledge and confidence of the digital agenda as they have done other aspects of health delivery. Health Education England has a digital development programme for boards and there are private sector offerings in this space too.

The challenges are many but the opportunity is unprecedented and there is a workforce in place that is committed to making this happen; they just need the right steer, encouragement and support.

Advice for boards

As ICSs are established, the key messages to leadership teams are:

  • Make digital a key thread of your planning and delivery. Take control of the strategy and ensure your digital leaders understand the commitments you are making to collaborate.
  • Ensure you have strong clinical leadership for digital that represents the full breadth of the clinical and care teams across the NHS and social care.
  • Bring your digital leaders out of the back office and make them an intrinsic part of the transformation – they might surprise you.

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Prepared by GGI Development and Research LLP for the Good Governance Institute.

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