How ICSs are using digital innovation - four case studies
Moving towards more digital services was one of the necessary changes highlighted in Lord Darzi’s recent report where he said that “parts of the NHS are yet to enter the digital era.”
Digital uptake is a complex picture. The Covid-19 pandemic led to an increase in the use of digital and remote technologies to help people access the “front door” of the NHS with online booking (including through the NHS app) and remote consultations. Whilst at the time this addresses the access needs and ability to get the right care, the ongoing ability of digital to provide care has been less successful since the pandemic. .
The pace and uptake of digital technologies has been varied across the NHS. A handful of trusts are still without a full electronic patient record while some are surging ahead with the use of digital technologies to triage, communicate and deliver care to a wider population.
However, a general lack of capital investment and ongoing financial revenue has held trusts back and some areas, such as community services, have yet to harness much of what digital transformation could offer them.
A National Audit Office investigation found many NHS staff felt that information technology created an additional burden for them at work where digital ways of working is hampered by a lack of updated IT, non-interoperable systems and lack of staff training and availability.
Lord Darzi was called for a “tilt towards technology” but this will require investment, both in the technology and in staff training. Ultimately staff will need to feel empowered by digital care and how this translates for their working day when accessing and using IT.
While the NHS may be in the foothills of digital transformation, there are pockets of exemplary practice where digital technologies are being used to help the workforce, empower patients and improve care.
Digital cafés
Accessing online health services such as the NHS App can be a barrier for some people and may impact on the uptake of them. But one-to-one support for those who are struggling may help overcome this. Buckinghamshire, Oxfordshire and Berkshire West integrated care board is working with city, district and county councils across its area to offer “digital cafés” where people can get tailored help. The 11 which have been set up mainly use library premises, making them easy to access.
Helping care homes with more medical information
If the NHS is behind in the digital revolution, care homes have often barely got off the ground. But with residents frequently requiring multiple medications and regular input from the NHS, there are opportunities to improve care by sharing more information and streamlining processes. Bedfordshire, Luton and Milton Keynes ICS is working with local care homes so they can order prescriptions and share medical information with the GP practices which look after their residents. That is saving time for all parties and ensures those who need to know about a resident’s health have access to the information they need. Some care homes are also trialling digital social care records which include observations such as fluid and food intake.
Using population health technology to fight fuel poverty
Fuel poverty has affected many people over the last two years but identifying those most at risk of developing serious health problems as a result is not always easy. Cheshire and Mersey ICS used population health technology to identify more than 1000 people facing fuel poverty and then to target them for support. These have included those with severe COPD living in deprived areas and pre-school children with a respiratory wheeze, which may indicate asthma which can worsen in a cold home.
Using AI to increase dermatology capacity
Capacity in dermatology services has been a headache for many integrated care systems, sometimes leading to long waits for diagnosis – a particular concern for those on the 2 week pathway for suspected skin cancer. AI increased capacity in services in Leicester, Leicestershire and Rutland ICS area by allowing photos of skin lesions to be analysed using AI, but with dermatologists reviewing if further investigation is needed. This has meant more than a third of patients have been discharged without needing a hospital appointment.
