In our final session of HTN Digital ICS, we focused on blueprints for supporting integrated care systems (ICSs) and heard from a panel of experts who have supported the development of blueprints and who have used them.
The session was hosted by Paul Charnley, Co-Chair of the Blueprinting Steering Group, and included a panel: Kwesi Afful, Assistant Director of Programmes – ICS Digital and Data; Holly Carr, Associate CNIO, NHSEI; Sally Deacon, Midlands and Lancashire CSU working with Cheshire and Merseyside ICS; Ed Beach, Head of Programmes Manchester FT, and Saj Kahrod, Assistant Director of Programmes – Blueprinting, NHSEI.
Starting off the session with an introduction into blueprinting, Paul explained how the team work within the NHS England Transformation Directorate under the ‘What Good Looks Like’ area. Their aim is to marry the dimensions of the What Good Looks Like programme with blueprints that can practically help others learn and benefit from shared knowledge.
Paul started by providing information on what blueprints are: “A blueprint is a collection of assets or knowledge that will help and allow people to do things that others have already done more quickly and cost effectively without repeating the same mistakes.
“The library covers a whole range of different aspects of digital from varying health and care settings, including the quite technical to the softer human issues, as well as including patient and staff views, and those from digital teams specifically on their projects and outcomes.”
He explained that blueprints are not instructions on how to do things, but are more of a step-by-step guide, which can be tailored to what you want to do. Alongside it are ready made artefacts such as job descriptions, terms of reference for committees, with communication documents for people to find useful in their own projects. Outlining the benefits, he stated: “The benefits of doing it are the acceleration of the whole process and being able to make decisions – we hope that people will get in touch with the authors of the blueprint and share good practice and learn.”
He continues: “We are particularly pleased when blueprints also point to better patient experience. Hopefully they will indicate the “bear traps” that are out there for people who are not careful and the risks need to be taken into account.”
In terms of relating blueprints to ICSs, Paul is looking for ICSs to support them in developing blueprints through sharing knowledge between organisations and finding patterns. He explained how they are looking to develop blueprints to inform how ICSs have done projects, that can be then shared more quickly.
“The blueprints are aimed at the priorities of improving healthcare and wellbeing, joining up health and care, and providing digital methods for delivery, but also there are blueprints about digital inclusion, so that’s an important aspect too. We are looking to develop the digital capabilities of staff within the ICS and they’re constituent organisations.”
Paul then handed over to Kwesi, who gave an overview of the priorities for an ICS. He first touched on how his team is supporting and working with ICSs, outlining a focus on the “nuts and bolts”, such as organisational data, systems and services from a local and national perspective, and how they are connecting into those hierarchies.
He said: “With digital collaboration technology, there are so many different guidances about what ICSs should do, we should be using the same systems, we should be trying to use the same digital tools to integrate care and reduce the burden on our care and health providers and experts.
“For example, focusing on core services – is there a benefit for an ICS to get economies at scale by coming together, ordering hardware and working together on certain contracts, rather than having contracts on their own? Each ICS is finding their own ways of working – we’re asking how we can help, and how can we deal with that and support every ICS work as efficiently as possible.”
Moving onto what they are trying to achieve with ICSs, he explained that there are four core objectives to consider, which are: “Enhancing productivity, tackling inequalities, helping the NHS support broader economic and social development, and improving outcomes in population health and healthcare.”
Coming in to talk next was Holly Carr. Holly spoke about digital transformation supporting ICSs and the ‘What Good Looks Like’ guidance for nursing. Holly started by sharing a project involving the National Digital Nursing team, who commissioned a discovery survey that was designed to screenshot the landscape of digital nursing at the moment. Holly identified some of the key themes.
“There is a variation in leadership, in terms of what positions are in organisations. There was massively varied responsibility in education and training and in understanding of the skills that are needed for nurses to really take a space in leading, and leading on this transformation agenda.
“In terms of where organisations were, the digital maturity within those were incredibly diverse, and we found that some organisations were really steaming ahead and were maybe 10 years in front of others who were just establishing an EPR system.
“From a research point of view, we also found that whilst there is data out there to do with the nursing profession, using that data and conveying it in a way that is impactful and could transform our practice and improve safety for patience and patience experience was something that hadn’t really been explored as much.”
Holly explained that the findings got them thinking about what good looks like for nursing from an ICS perspective. She understood that the WGLL framework outlined how integrated care systems can work to best support care through digital transformation, with the guidance aimed at nurses in leadership positions who oversee digital portfolios implemented by the seven success measures.
The seven success measures in WGLL Holly outlined were well-led; ensure smart foundations; safe practice; support nurses; empower people; improve care; and healthy populations. “From a nursing and ICS perspective the ability to share good practice across boundaries, to be able to share across the network and to be able to up-skill and uplift together, is something that really will be facilitated by capturing that practicing case studies on our blueprinting and sharing that more widely as well.”
Next up was Sally Deacon who shared with us a programme on home blood pressure monitoring across Cheshire and Merseyside. Sally shared the approach, the tools they used, how they ensured adoption and how blueprinting helped them to scale up their approach across the ICS. She started off by highlighting how high blood pressure “is known as a silent killer – it is also the biggest area that collectively patients and the NHS can save lives and prevent life-changing events such as a stroke or kidney failure,” Sally said.
For Cheshire and Merseyside, Sally shared their three phases of the project, and explained that they are entering ‘phase three’ of the programme, where they will be taking the blueprint to all remaining places. They will be scaling and supporting the model across the entire ICS with the intention of setting the BP@home monitoring as an additional pathway for patients ,and to be business as usual for general practice across the entire ICS by 2023.
The benefits of blueprinting have been wide-ranging: “I started with seeking the prize that someone, somewhere has already done this, or attempted to do this in some form. Given that the NHS is always evolving, there is so much capability and experience out there. So we built our own.”
Other benefits included opening up doors into other parts of long-term condition management such as areas of social care, age care and the ambulance service. She said: “Our blueprint hopefully will truncate for you some of the journey we have been on and give you some useful pointers of the process – it’s certainly going to help us in our remote monitoring journey.”
Last up was Ed Beach speaking about Manchester NHS Foundation Trust’s project with clinical system supplier EMIS, and their experience with blueprinting. The benefits of blueprinting for MFT gave an opportunity of a deeper analysis of the benefits realised in the programme, in addition to their programme closure activities. For Ed, blueprinting helped him understand that in more depth and he was able to put more depth into their benefits realisation measurements.
The blueprint process also provided an opportunity to reflect on the lessons learned to plan ahead. Ed said: “For the next steps the blueprint is going to help us understand what worked well and how we overcame barriers.”
Ed continued to discuss how the blueprint provides technical detail, including how long it can take to move, migrate or implement initiatives, as well as touching on culture alignment and communication.
“ICSs can use blueprints to understand lessons of what worked well, have there been challenges and how they’ve been overcome. Consider new or different approaches delivered in other places, have a high level of understanding of the likely risks and barriers or benefits and how they have been realised since the start of the project, how have things been done? And understand implications of ongoing pressures.”
We would like to thank all attendees for sharing their experiences and taking the time to talk with us. You can watch the webinar below.