The introduction of integrated care systems (ICSs) is a significant moment for health and care as a vehicle to bring scale and structure to the ongoing integration agenda. The consistency of recent policy direction, now aligned by legislation and funding, provides a platform for significant strides forward.
The problem today is that the promises of ICSs are intrinsically linked to their key challenges. ICS leaders are facing real challenges that cannot be oversimplified and these challenges will ultimately impact their ability to deliver on their promises. While funding is coming together, it’s unclear how ICSs will impact commissioning, financial flows, budgets and ultimately health outcomes, at least in the short term. Achieving care model transformation and system sustainability will be complex and requires a generational level of change.
The implementation will require insight, imagination and long-term commitment. Critically, ICSs are not simply about financial sustainability. At the heart of every care system is a patient, their loved ones and a clinical community trying to support them. As ICSs deliver, they do so in the context of fundamental issues such as safety, quality, inclusion and lived experience.
The NHS is a great national achievement, full of people who strive to deliver the best possible service. It is, however, a service constrained by the weight of its own history – past structures, incomplete reforms, unfinished programmes, plus the sheer ‘weight of everyday’ in the system.
As a leading provider of NHS enabling services – nationally, regionally and locally with our dedicated teams working in partnership with the NHS frontline 24/7 - we’ve experienced some of those same challenges and recognise this weight.
Have suppliers oversimplified the challenges of the NHS?
Oversimplification isn’t helpful within the health ecosystem.
“Weary staff” – offered a wellbeing app
“Out of hospital” – apply AI to drive population health impact
“Health inequalities” – use an algorithm to get insights
“Virtual ward capacity” – deploy a Bluetooth device
Does this sound familiar, have you heard this all before?
Technology has been the ‘future’ for health – for decades
The reality is the potential value of digital and data is massive, but it hasn’t always been applied in a way which takes the pressure off real frontline NHS problems. Of all the problems faced daily, a critical one to highlight is the lack of time.
Lack of time risks undermining everything while sapping resilience. The NHS frontline simply doesn’t have time to compensate when technology is implemented poorly. Instead, we need to focus on connecting data and technology to the NHS and people’s lives on their terms, enabling them to gain value from it, quickly.
Meeting the NHS’s terms involves understanding the implications of culture, incentives, training and performance management. Unless these complexities are understood, the negative outcomes they cause risk becoming normalised. In the words of the Academy of Royal Colleges September 2022 paper – “we must stop normalising the unacceptable”.
Technology-driven oversimplification was perhaps best illustrated to me when a hospital consultant asked, “Can you provide a service which takes all these apps, and decides which are good and make sense in the context of real things like pathways, practice and standards? Because I don’t have the time.”
Simplicity is not always the right answer
The Royal Colleges advocate a whole person / whole population model across 10 areas. Critically, all the areas highlighted are complex, but only one is centred on digital. Oversimplification is not solving problems; it’s compounding them with a blizzard of simple answers, but with limited means to understand what will be effective.
Simple answers are likely to be poorly integrated into real care systems, more costly and less sustainable, focusing on the symptom, not the cure, and often without the ability to scale, flex or transform. Simple answers are also unlikely to deliver the ICS agenda.
The challenge suppliers face is that the NHS is constantly evolving and leadership capacity is often constrained. Suppliers therefore construct alternative, simpler realities to frame their current narrative, but in reality, ICS structures operating in five years will probably be quite different from the ICS structures envisioned today.
Therefore ‘scaling’ and ‘flexing’ isn’t a technology question, but an organisational and financial one, alongside helping the NHS make best use of what it already has and to understand what it needs next. A good example is ‘virtual’ - far more than just technology. It’s about the fundamental model of care and critically, how we enable and sustain that transition.
The sustainability and resilience of health systems will depend on issues such as shared services, optimising staffing, spending, and training, streamlining, integrating, and optimising processes. These issues by their definition are complex, sensitive and on face value cut across agendas such as the localisation of services. There are balances to be found, but these will likely only come with time. Above all else, we must retain focus on patients and their loved ones.
Overcoming oversimplification by managing complexity
The NHS and more specifically ICSs will need to address many complex issues in the coming years. There’s a question as to whether ICSs can do this on their own or whether there should be a re-evaluation of the potential for new partnerships to deliver against the challenges the NHS faces.
From our experience of talking to ICSs, we know that right now they’re focused on helping and supporting their provider organisations in delivering patient care against a background of staff shortages, constrained resources and uncertain finances. At the same time, they’re working to integrate health and social care services to create the services needed to meet their population's need.
But is doing both sustainable without wider help?
What more could be achieved if the NHS had a partner who promised more than to simply solve a problem, but helps them to remain effective in the face of the diverse challenges it faces daily? Partnerships can, and do, bring a lot to the NHS. But there is a limit.
Partnerships probably can’t help in plugging the gaps in the clinical workforce, nor lead the integration of services for patients. However, used properly, they can help in reducing much of the additional non-clinical workload that, as every clinician will tell you, forms a frustrating part of their working day. Partnerships can bring both capacity and innovation to automate and optimise low value, non-clinical activity.
We’ve worked with the NHS, central and local government across the UK for decades. Capita has evolved with, and supported, the NHS in the face of its real world and everyday challenges. As one of just a few organisations able to support the public sector at scale, we can support the NHS on its next major step and the realisation of integrated care.
We’re already delivering complex, critical services for patient engagement, people and skills, productivity, sustainable delivery, and estates and infrastructure. We deliver to excellent standards and with a real partnership ethos, rewarded with customer satisfaction scores as high as 98%. If you’re on a difficult journey, what type of partner do you want? One who hopes for simplicity, or one who copes with complexity?