Many years ago, I worked for a health technology company. It was the early days of the NPfIT (National Programme for IT) in the NHS, which largely meant ‘enterprise’ products and ‘big’ managed services. I was asked by a boss, “What is integrated care and what can we sell into it?” I wasn’t sure, but was told to come back with an answer. The desired response was something that involved a reworking of big enterprise and ultimately legacy, but my colleagues and I knew that in reality the answer had to be different.
Fast forward a few years and the rise of integrated care systems (ICS) seems to give integrated care a real platform, the culmination of a consistency of policy and legislation that will enable the structures for significant integration. It is, in my view, a moment for real optimism.
But optimism can struggle with reality and opportunity can be squandered by lazy legacy thinking.
While policy direction such as the NHS Long Term plan gave a bearing, ICSs are developing their own interpretations intended to focus on the dynamics of local need. With this comes many questions. Do health, social care and local government feel fairly represented and treated as equal partners? Will all the providers accept the implied shift in power in local systems? Moreover, what can previous examples of integration, such as regional devolution and what they’ve delivered (or not), teach ICSs going forward?
It will take time for everyone in the system to come together and realise what it all means.
Above all, ICSs have been introduced into a world where there is a Covid-19 backlog, the economic challenges are worsening and the resource challenge is extreme.
The NHS is at the heart of a rich eco-system of skills and experience. One of its strengths is the ability to partner with other parts of the system e.g., social care, the voluntary sector and also with the private sector. The quality of successful partnerships depends upon a commitment to support, enable and critically evolve as the demands change. There’s no option in an effective partnership to be static – and the ICS agenda is anything but static.
New challenges, old thinking
Many suppliers may be thinking “What are ICSs and what are we selling into them?”; rather than evolving that thinking to support their successful operation, changing their focus to the real challenges ICSs are facing. Too often, I see suppliers using the ICS agenda, like integrated care, as the latest narrative to apply old thinking and solutions to. This is in a world where many ICSs are still trying to work out what they actually need.
Faced with these complexities, here are some examples of how I believe thinking should change.
1. The data interoperability challenge
This isn’t really about technology, it’s more about tougher, ingrained issues like trust and incentive, for all parts of the system. The ‘interoperability mantra’ often lacks any real reference to real impact on patient care or the clinicians’ experience. Even though data is one of the most critical opportunities for the NHS today, why is it still reduced to a ubiquitous technology concept from over a decade ago?
Considering the recent success of NHSApp, why doesn't the data integration debate focus more on the practical next steps that have closer direct relevance for patients, their carers, and the clinical community?
2. Virtual wards
A virtual ward and other virtual services, such as digital first primary care, digital outpatients, and patient-initiated follow-up, are fundamentally dependent on clinical and patient trust. But the supplier community has largely focused on remote monitoring as a technology challenge alone.
It remains to be seen if any significant change in the number of beds available and occupied can be attributed to a behavioural factor rather than a technical one. Currently, most solutions are technological deployments that do not reflect the nature of the transformation needed or critical factors such as clinical buy-in, patient experience, effective communication and protection of clinician / patient relationship and trust.
3. Risk and reward
The relationship between risk and reward in transformation has always been questionable and, in the face of current challenges, even more so. Are traditional advisory methodologies and programme models fit for purpose – especially for patients, carers and clinicians? How many transformation-led programmes delivered long term and sustainable value, in real NHS terms, demonstratable long after the programme ends? We don’t believe risk-reward should be based on overly inflated day rates and a narrow definitions of risk. Rather, we believe new commercial and performance models are required to align suppliers to the long-term goals of the NHS, patient outcomes and the delivery of sustainable improvements.
4. Service federation
The essence of integrated care systems will be the creation of federated services from multiple providers. Besides data interoperability, there’s little information about how suppliers will enable practical service level integration across multiple domains of change that meet the overall system’s needs. How are opportunities for new services, reorganisation or rationalisation being supported at all levels, including localised structures like Primary Care Networks (PCNs)? Has this been reflected in the way the supplier community has been utilised towards delivering point solutions to a single customer or monolithic shared services?
Our role as a supplier
I believe all suppliers must be more perceptive and intelligent, to deliver against key challenges such as productivity and quality, and to make our work relevant to patients, carers and clinicians.
At Capita, we believe in the integration agenda and are proud to support ICSs with intelligent solutions that deliver long-term, system wide economic sustainability and make a valuable contribution to agendas such as levelling up.
We scale our services from the national to regional, to locality or place. Our delivery is based on long-standing trusted delivery partnerships where our services evolve with our customers’ needs. We back ourselves, innovation and our commitments by taking the right actions for you.
We believe there are four fundamentals ICSs should consider to deliver their objectives successfully and where we’re ideally positioned to help:
1. Taking a people centric approach - healthcare is and always will be about people. We focus on people, training and skills, where agile and sustainable workforces are at the heart of the solution.
2. Scaling - with proven, scalable capabilities for the frontline and back-office across technology and advisory services, our scaling is agile, consistent and based on local needs. There is no ‘one-size-fits-all’ or ‘monolithic outsource’ and we know there is limited value trying to second-guess the shape of healthcare in future.
3. Sustainability - we deliver system-wide economic sustainability as transformation must be sustainable over the medium to long-term. As a partner, we have a role, share and risk in ensuring sustainability is achieved as a key outcome, measured as the basis of a new style of relationship.
4. Implementation focus - we focus while evolving, partner while delivering. We deliver services right across the NHS and the public sector daily and we understand change because we live it daily. Trusted by our clients, we demonstrate a daily commitment to partnership though evolution and practical agility.
Bringing these elements together intelligently, we focus on a combination of design, data and practical service delivery experience. We integrate our services into the NHS to enable one service. The only constants the NHS can rely on is pressure, change and uncertainty. In this context, our role is to step up, do more and intelligently bring essential service delivery to life.