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NHS England recently published the 2020-21 NHS Operational Planning and Contract Guidance – a weighty document that has at it’s core the continued implementation of the NHS Long Term Plan (LTP). The LTP seeks to deliver much needed transformation of services and outcomes within the NHS by 2023/24.

The objectives of the LTP are broad ranging, ambitious, and require collaboration within the system like we’ve never seen before. But the potential benefits of the LTP are significant:

  • Improved access to services.
  • Extension of services into the community.
  • Operational reform.
  • Investment in essential health and wellbeing services which we’re currently lacking and much needed by society.
  • A shift from a break fix service to one of prevention.
  • A focus on ensuring that the NHS is properly resourced in order to deliver.
  • Progress is unquestionably being made, with greater levels of collaboration happening across the system. But it’s tough. Entities need to merge, services need to be redesigned, transformation needs to be implemented; and real progress requires reform at the core of the NHS operating model… and we haven’t yet mentioned Local Authorities.

    Integrated care systems and any remaining sustainability and transformation partnerships are expected to transform their governance and financial arrangements this year. They are also expected to develop key capabilities including, in the tech space, population health management. Specifically, how we make the best use of insights drawn from data to improve health and wellbeing now and in to the future, either by preventing illness or by improving commissioning and access to the services needed by a community.

    The recent guidance also suggests that one of the ways that hospitals could increase capacity is to reduce the number of face-to-face outpatient appointments that they run. In fact, it devotes a whole section to ‘outpatient transformation’, video appointments and digital follow-up.

    NHS organisations will be expected to invest to get their technology up to scratch, as defined by new, national, digital maturity standards and a list of "high-impact, productivity-enhancing solutions" that they will be expected to deploy; with the help of new NHSX deployment teams, if necessary.

    So, what’s key to building viable integrated care systems?

    It starts with good, collaborative, governance – that sets a clear framework for operation, is led by a clear strategy that’s been co-created with key stakeholders from its operating environment, which enables autonomy within it’s ‘system’, implements effective lines of communication and regulates variety to improve viability and scalability.

    This means change. This means leadership dropping the boundaries of the organisation, embracing new ways of working, releasing control, creating empowerment and proactively designing a new future.

    Reform – starting at Board-level.

    But, most importantly, this means truly putting citizen health and wellbeing at the very centre of every consideration; and working collaboratively with other public services to create joined up health and care.

    There is of course the danger that integrated care systems will establish themselves with local nuances which create differentiation and may generate further challenges in the future, but we have to start somewhere – and in the absence of a national framework, it requires local action.

    But, where does digital fit in?

    Digital is a transformation enabler. Having the ability to put the right information, in the hands of the right care providers, at the right point of care, across an even more complex landscape, is critical to achieving the LTP.

    And, more importantly, critical to improving the service our invaluable NHS can deliver. Achieving this across an integrated care system is essential, primarily for the effective delivery of care – but also for the governance of a new, larger, organisation. That’s the first step; beyond the walls of our hospitals and treatment centres, being able to use data to empower citizens to take ownership of their own health and wellbeing is where the real potential for transformation exists.

    Imagine helpful reminders and practical guidance on maintaining a healthy lifestyle, perhaps even prompted by analysis of family or geographic health trends (or even just the weather!), remote support for managing complex conditions, and treatments, as well as remote consultations – the possibilities are almost endless. Digital is about people more than it is about technology.

    We know that the technology is capable, if the appropriate technology is procured and implemented well. We seem to find it harder to ensure people are placed at the centre; and I think that’s our challenge for the next period of LTP implementation.

    What’s happening on the frontline of implementing shared care records?

    We’ve already started working with a number of STPs to help shape their approach to developing, and implementing, shared care records – both across healthcare organisations, but also with local authorities.

    We know interoperability is key and whilst we already have mature standards for data exchange, and solutions that can make use of those standards – there are a few challenges. There are typically variable levels of digital maturity across the organisations which now need to improve how they exchange data; they can be nervous about information governance and they typically aren’t sure how the public will react to their data be shared.

    Each of these challenges can be addressed. We need to work together to raise the digital maturity across a system so that each organisation reaches a common acceptable level, before investing in any one part of the system advancing ahead of others. We also need to lower the walls and take a people-centred approach – engaging internal and external stakeholders in designing their future – without this, too many assumptions are made without the right quality of engagement with those who can help address the challenges.

    Together, we can safely and confidently build the interoperability that can underpin the design of services and the delivery of care across Integrated Care Systems.


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