For our second session of HTN Now September 2021, Jonah Aburrow-Jones, Director of Digital Health Maturity, Strategy and Consulting at Ideal Health, stepped into the late morning slot with his presentation on ‘Realising What Good Looks Like’ in Integrated Care Systems (ICSs) – and his views on the latest NHSX guidelines.
Aiming to break the detail down from the official document, Jonah provided his thoughts on the framework and how it aligns with work already underway in many ICSs. He said: “This is going to be the biggest change we’ll see in the NHS, for a long time [the CCGs and ICSs coming together]…I’m hoping from what’s being talked about within ‘What Good Looks Like’ (WGLL), the new ICS Design Framework, [and] the NHS Data Strategy that’s come out will provide the support needed and that the NHS has learned from some of the things we’ve encountered in the past.”
Highlighting the “unique time” and that there’s “no comparison” to the stresses over the last 20 months during the COVID pandemic, he added some background to put the release of ‘What Good Looks Like’ into context.
“When we actually see what it [WGLL] has come out with at this stage, the detail is relatively light and it’s tied into ‘Who Pays for What’ and the new Unified Tech Fund. But, above all, in terms of everything that’s taking place at the moment…there is no change in that target of 1 April next year, for the integration of CCGs and ICSs. This is why ‘What Good Looks Like’ is needed right now…[the timescale] is a really significant challenge,” he said.
Focusing on the ‘seven success measures’ featured in the framework, Jonah recapped the main areas: well-led; ensure smart foundations; safe practice; support people; empower citizens; improve care; healthy populations – and how they come together under ideas around transformation, and connecting and digitising care.
While noting that WGLL is welcomed, Jonah also raised concerns and provided some food for thought. He said: “I think it demonstrates [that] the centre is actually listening to organisations on the ground – what are the issues and what’s needed to try and move the needle in terms of improving and changing that. Alongside the WGLL, the simplification of funding and creating more of a focus on health outcomes, patient, empowerment, and population health, is all good. Particularly, the focus on digital inclusion [too], which has been a real focus for a lot of ICSs.
“It really well aligns with many of the ICS needs and the priorities that they already have. Above all, it really does give that foundation for moving away from silos in care.”
On the “however”, Jonah also made sure to point out some areas of the plans that require improvement. His constructive overall feedback was: “Understandable concerns here [are] the real lack of specifics within the guidance and framework, as it’s been released at the moment. It also, perhaps, underplays the magnitude of the task at hand. When you look at each of the individual seven categories, there’s just a huge amount of work that’s entailed within those – and it’s not just digital. The technology part, in some respects, is the easiest part.”
Yet, he added: “Overall, you’ve got to say it’s a positive. If there’s nothing necessarily new or revolutionary within ‘What Good Looks like’, it does have a framework, which actually demonstrates the fact that digital leads, clinical leads [and] care leads have actually been listened to.”
“Although NHSX says it intends to provide more tools, blueprints, digital maturity assessment frameworks, case studies and so forth – many of those aren’t currently available, so while WGLL has been launched, maybe we should look at it as a soft launch without all those tools being available. That’s going to cause some problems because, whilst many ICSs have been sat waiting for the WGLL to actually happen, not having those tools does mean that there aren’t the enablers to start realising the WGLL, particularly when it comes to the Unified Tech Fund and the need for digital maturity to be evident alongside funding applications,” he said.
Continuing to discuss what’s “missing”, Jonah commented: “A how-to tool or manual seems to be missing at the moment. A lot of good intention but, in terms of realising it – what to do, how to do it – that’s still a little bit of a question. Perhaps a different way of looking at it is the centre not wanting to enforce a centre-down approach, like what we’ve seen in certain other programmes in the past, allowing organisations the flexibility to realise what they need to do and how, and how they need to do it at a local and regional level.”
Another area of feedback that Jonah covered was the “minimal references to Places [ICPs]”. The “ICSs and CCGs coming together and integrating”, he said, “is a positive thing”. However, he also noted that the “problem with the ICS [is] the ICPs are really going to be the organisations on the ground realising and the implementation and delivery of care” but that the “amount of work that’s going to be required in supporting those isn’t necessarily reflected within ‘What Good Looks Like’.”
“There’s a danger that as things continue,” he explained, “that ICSs could end up reinventing the wheel, as they put these different guidelines into practice.”
He also noted that the framework had “come out of NHSX” but not the Department of Health and Social Care – and that “a lot of what’s talked about doesn’t really address social care.”
Jonah then went on to share his learnings from the last year or so, when working with clients such as ICSs, and how they relate to WGLL, as well as taking a closer look at the ‘critical issues for realising WGLL’. His areas of focus included: each ICS only being as mature in its digital enablement as its least mature provider; the considerations for assessing digital maturity; different levels of understanding on WGLL across digital, clinical and operational domains; how the WGLL categories roll-down into impacting care for patients; digital maturity vs usability; waiting for help and support; governance being key; interoperability and addressing cross-ICS border care; impact on waste and clinical safety; and worrying about the ‘big stick’ eg lots of expectations and not enough resources.
To sum-up, other issues and challenges that Jonah felt could be better covered – or weren’t adequately covered in WGLL – are: no mention on the level of change management; place-based support; the resource drain; missing tools; there not being enough of a focus on regional infrastructure; cross-boundary care; legacy systems; not addressing those who can’t access care through a Digital First approach; and there being no reference to the draft paper policy ‘Data Saves Lives’.
After also putting ‘Who Pays for What’ under the microscope, Jonah concluded the session with a summary of his main points, and added: “Support is available…I’m sure that there’ll be further detail coming. In the meantime, as you need to make progress, reach out – [I’m] always happy to help or point you in the direction of people or other organisations who might have done something similar [or] in a different way. I’m happy to share that with everybody.”
To watch the full session, view the video below: