ICSs are feeling the weight of NHS responsibility on their shoulders. But Malcolm Lowe-Lauri sees this as an opportunity to take advantage of place data to drive lasting change.
If you’re an integrated care system (ICS) Chair or newly-appointed executive, you'd be forgiven for thinking the most egregious of the NHS’ challenges are being handed to you:
recovery of NHS services
arranging the provision of health services
developing a plan to meet population health needs
allocating resources across the system to meet the plan.
It will be very easy to start by putting in the people and the governance (as per the design framework) and getting consumed by the plethora of NHS backlog requirements, especially in elective care and cancer.
But there are things we can draw on to allow the future to help the present:
data about our place to understand what we'll likely need to do
lessons from lockdown to show what we don’t really need to do
our networks to learn how others have done
emerging science and technology for elements that are already available.
Some of the more-progressive ICS are using data about their place to understand demand in ways that are more than 'how full are we and how many people are waiting?' This has already been going on in local authorities in Greater Manchester.
ICS can use place analytics to drive change
These clients use our place analytics to predict demand drivers for social care and mental health services, so they can shape services accordingly. We're doing similar work for health boards in Wales and trusts in England thinking about the redevelopment of their hospitals.
During some of these engagements, it's been interesting to hear from clients like Cardiff and Vale how the last year has prompted both clinicians and their patients to rethink treatments that may not actually be necessary. A fresh look at the evidence for the benefits of treatment may have quite an impact on volumes of elective care, although, of course, plenty of it will still need to be done.
If ICSs have more than one trust in their footprint, and with provider collaboratives, and health and care partnerships as parallel parts of ICS development, that creates quite a network for problem resolution. That network should include patients, relatives and carers.
ICS concerns about staff shortages
The current angst about workforce shortage is understandable. But if patients are added to the workforce with support and technology to manage more of their care that will help change the balance. Compared to much of the service economy, we've been slow in handing responsibility to NHS consumers.
Our colleagues at Academic Health Solutions, with whom we do our clinical strategy work, have done a lot to understand what is ready, impactful and adoptable from the emerging science and technology.
This is more about platforms than 'gizmos'. And this hasn't been lost on many of the clients, including programmes for new hospitals at Princess Alexandra Hospital in Harlow, Northern Devon and Cardiff and Vale, that are grasping the opportunity for a genuine service transformation, both for themselves and the wider health system.
Much of this can start now. This will certainly help deliver the ICS NHS body remit for “a plan for the health needs of the population”.
The opportunities for healthcare transformation
The above provides an option beyond the search for more workforce (already feeling the effects of more than a year of lockdown) and more facility capacity. And it speaks to the long-term ICS responsibilities – planning, resource allocation and continuous improvement.
So, we can take learning from the present and methodology for the future to:
Create an understanding of science and technology
This especially includes the major platforms that will influence our ability to change the shape of services:
machine learning/artificial intelligence
precision diagnosis and treatment.
Create opportunities in terms of population risk stratification
This includes life course planning for patients and precision prevention planning. This will allow the ICS to focus on those at risk of illness as well as acting as the 'repair shop'.
We already see this in how the Elizabeth Garrett Anderson Hospital, part of UCLH in London, approaches its women’s services.
Take this into an improvement methodology
This needs to work for ICS strategy and population health planning. The conventional improvement methods are not enough, the technical changes we can make offer so much and have to be factored in as described above.
Generate demand and capacity planning
We need to ensure this reshapes service organisation and delivery across the ICS. A chance to get on the front foot in how we plan.
It’s interesting to note how much 'demand and capacity' has become a buzz phrase in current times. The ICS now has a chance to do this fundamentally.
Understand digital and workforce requirements
The digital challenges for the NHS are well-known. Digital development is coming across as a must, whether it’s about building a new hospital or generating data to understand the health of the population.
Many of the new hospital programme candidates are running digital transformation alongside new buildings, while some are prioritising digital investment. A CEO recently told me spending £100 million on digital development was much more important than building a new hospital.
Seizing the opportunities for ICSs
The opportunity through data and technology means more will be available to GPs and their patients to use in a management partnership.
That also requires a partnership between secondary and primary care, with clinicians increasingly as data analysts. And it sees everyone going back upstream to the patient. This has got to be an important message for hard-pressed clinicians feeling exhaustion and contemplating retirement – a new and more sustainable form of work.
It goes without saying that this kind of journey needs capacity and capability in the leadership workforce. If we think about the clinical engagement requirements across a health system, on to local authority services and the wider determinants of health in the domain of public health colleagues, the mobilisation requirements are considerable.
It will require a full range of knowledge, experience and wisdom, both inside the ICS and from any advisory support it draws on. This is about models and methodologies, but it’s also about expertise that we can co-develop with your experts.