Developing a digital blueprint for success

Integrated care leaders don’t underestimate the magnitude of the task they’ve been given. And they understand too that the ambitions of integrated care systems (ICSs) can only be achieved by harnessing the digital agenda. As part of our Digital ICS programme, we’ve helped integrated care boards (ICBs) begin to understand their role in bringing about digital changes.

Over the last few months, we've had conversations, scoping calls, interviews and informal discussions with our networks and members across the ICS landscape. The diversity in ICS leadership roles has given us rich insight into the current state of play of the digital ambitions and journeys of systems, and we’ve begun to build a strong picture and understanding of how ICS leaders - executives, non-executives and partner members - are improving their confidence and understanding in leading the digital agenda.

What we’ve heard

What stands out most from our conversations and engagement is that ICSs remain overwhelmingly willing to succeed. We’ve heard that ICS leaders want to add value to the work already happening within the system. For example, if a trust within an ICS is procuring a new electronic patient record (EPR) system, how can the ICB avoid duplicating the assurance role of the trust board by asking the same questions about value for money, resourcing and implementation? Answering this involves the ICB considering its unique strategic role and position in the system to add value to the work already underway. This might include bringing in support from another trust in the same system.

As there is not yet a blueprint for what success looks like, ICBs are convening and influencing across their system. For digital, this means helping partners understand and align on what their shared priorities are, where everyone’s capabilities sit, and developing shared language around digital and data.

The biggest culture change for me will be when I can stand back because people are connecting by themselves

One ICB chief digital information officer (CDIO) we spoke to described what they had focused on in the first 12 months in the role. They said they had started by getting people talking about the priorities at place level, which involved ‘show and tells’ between different organisations. They then sought to grow confidence levels, trust and alignment with and between partners. In one exercise, the CDIO brought a group together and asked them to write down their biggest challenges and share them back. “Everyone is doing brilliant stuff”, the CDIO told us, “but it’s all different stuff. The biggest culture change for me will be when I can stand back because people are connecting by themselves.”

What we’ve learned

…once you’ve seen one ICS, you’ve seen only one ICS

There is a maxim that ‘once you’ve seen one ICS, you’ve seen only one ICS.’ Not only do ICSs vary in size and geography, but they also vary in terms of their partnership working, and how they are set up beyond just the ICB board itself.

Many ICS leaders are also still getting to know each other. Many CDIOs in post are interim while permanent posts in this profession continue to be recruited for. This means some ICBs are not getting past the ‘forming and storming’ stage, which fundamentally has an impact on being able to get on and deliver and realise their digital potential. Therefore, there is a need to build awareness of what work is already underway within their patch, but also to strengthen relationships with partners. Bringing this together will be fundamental to help develop and then deliver ICS digital strategies.

Below board level, different groups are forming to help support delivery and give digital programmes direction

Before we started our programme, we anticipated the need to frame digital through the lens of the four core purposes of ICSs: improving population health; tackling unequal outcomes/access; enhancing productivity and value for money; and helping the NHS to support broader social and economic development. All board members are familiar with them, and keen to progress them, but want to understand more about how digital can act as a key enabler.

Below board level, different groups are forming to help support delivery and give digital programmes direction. These groups are even newer, and can often incorporate a range of stakeholders from across the ICS. And it’s not just CDIOs acting in these groups below board, there are chief medical officers, strategy directors and other clinicians taking an active role.

What we’re doing next

From gaining these valuable insights, we now intend to capture and share this emerging good practice. But this isn’t a one-off solution, it’s about providing ongoing support to the sector.

In our next few sessions with ICBs, we’re going to surface where ICBs and ICSs need to do further work. Given change, and the slimming down of ICBs, it is important we provide support for greater collaboration and help facilitate difficult conversations. We’re going to continue to help ICBs develop a common language to talk about their joint digital vision and priorities. And we’re going to continue to push ICBs to get buy-in from diverse organisations across their system to ensure there is genuine collaboration and partnership working embedded into the next phase of digital delivery across systems.

Rezina Hakim is senior policy adviser at the NHS Confederation. Adam Wright is programme development manager at NHS Providers.

You can follow Rezina and Adam on Twitter:

@hakimrezina

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