Video: Cheshire & Merseyside ICS on developing an outcome-focused ICS strategy

Representatives from the Cheshire and Merseyside Integrated Care System (ICS) joined us for our one-day HTN Now event, focusing on developing digital ICSs, where they led a session discussing the approach they are taking to ensure that their digital and data strategy is intelligence-led, outcome-focused, auditable, and informed by the public.

Jim Hughes, Strategic Advisor for Digital Programmes at Mersey Care NHS Foundation Trust, was present for the session along with Adam Drury, Associate Digital Specialist at the Mersey Internal Audit Agency (MIAA).

Adam began the session by sharing some information about the Cheshire and Merseyside ICS landscape. As one of the largest ICSs in England, it is made up of nine local authority areas or “Places”, 17 NHS providers and 51 primary care networks, covering a population of 2.7 million people.

Cheshire and Merseyside have had a digital strategy in place since 2018 which runs until 2023. “We’ve been working on refreshing that strategy, but taking a slightly different approach,” said Adam. “Firstly, we’re expanding it from what was originally predominantly a digital strategy to a digital and data strategy.”

This change has been driven by five key principles: the strategy must focus on outcomes for the local population, it must be intelligence-led, digital and data driven, inspired by the rich diversity of people living in our footprint, and focused on the delivery of the ICS’s objectives and service priorities.

Adam shared how the ICS’s approach is based on five key workstreams:

  • Transformation Outcomes Mapping, through which the ICS is working to confirm required transformation outcomes through its major system wide transformation programmes, confirm population segmentation and personas for the strategy, understand improvement opportunities based on each programme or segment, and confirm baseline data for key outcome measures.
  • Digital Maturity Assessment, with the ICS using a ‘What Good Looks Like’ (WGLL) baseline maturity assessment for Providers, Places, and the System, confirming required levels of future digital and data maturity, and identifying gaps between baseline and future requirements, primarily at a Place-level.
  • Public Engagement, necessitating the identification of key priorities for improvement and expectations in care delivery across agreed population segments, along with running events by segment to engage on the issue of how digital and data capabilities can help to meet expectations and deliver improvements in care provision.
  • Digital and Data Capabilities, with the ICS identifying these capabilities for delivery at scale to support improvement opportunities and validating them with key stakeholders.
  • Fully Costed Digital Plan, with the ICS required to quantify the investment required to bridge gaps, creating a prioritisation framework for investment, and developing a costed investment plan for approval alongside the ICS Digital and Data Strategy.

“This approach is very much inspired by conversations we’ve had with other ICSs,” said Adam, giving particular thanks to the ICS team in Greater Manchester for sharing their ideas and approach.

Adam shared that the session would place particular focus on the first of those workstreams, ‘Transformation Outcomes Mapping’.

Taking a moment to look at some of the transformation programmes across NHS England and Improvement and the Cheshire and Merseyside Health and Care Partnership (ICS), Adam commented that it’s important to look at “what you’re currently trying to deliver… what are the outcomes you are trying to achieve? What are the improvement activities you are looking to get in place? Where is digital and data already impacting that, and where do you see it impacting going forward? What can we do to work together and support you in delivering the outcomes? That’s the start of the outcomes-focused approach that we are going to work on.”

When it comes to planning actions to take via the Transformation Programme Mapping Approach, Adam said, “We started off by going through all the documentation associated with each of those transformation programmes… we started to work through interviews with the programme managers, the clinical leads, and members of the Transformation Programme team, to really understand what they were trying to achieve, their current status, and where digital and data could support them.

“Then we produced a summary map showing that link between the outcomes, improvement opportunities, and where digital and data could play a role. We played it back to those programme leads and clinical leads to make sure that they were validated, and then published it.”

Here, Strategic Advisor Jim Hughes took over the discussion to shed more light on the mapping work.

“We use this well-known concept of turning the dials,” Jim said. “We wanted to be able to say that patient outcome X from one of our programmes is enabled through a particular service improvement, which is then underpinned by a particular investment in digital and data. A key thing about that is that this particular outcome is traceable or auditable in some way. So, if we say, ‘we are doing this particular digital intervention’, then we will know that [the intervention] has an impact either directly or indirectly by turning the dials on the patient outcome. If you’re going to be outcome-focused, you very much want to be explicit about how the intervention turns the dial.”

Jim shared an example from one of the ICS’s programmes, Ageing Well, including some of the outcomes that they are trying to achieve through the programme, areas identified for improvement, current digital and data solutions and KPI mapping.

Showing how these factors link together, Jim highlighted a specific example. “The outcome that’s trying to be achieved is for the patient to be discharged from hospital to a virtual ward where they can be safely monitored,” he said. “The opportunity for digital intervention is to reduce physical bed use in the acute setting. The digital and data solution was to support a tenfold increase in virtual wards. The specific mapping for the KPI was around virtual ward bed numbers.”

Jim moved on to look at the transformation programme from the point of view of the NHS Long Term Plan and the 22/23 Planning Guidance. By taking this approach, “we are able to say, with confidence, that based on the digital interventions, we will meet the long-term plan outcome measures for Ageing Well. And we can meet all of the board metrics that come out of the transformation board meetings.”

There are other requirements that must be met, and which influence investment plans, both on a National level and at a Place level, such as levelling up in electronic patient records, meeting the digital maturity requirements set out in ‘What Good Looks Like’, and identifying digital and data needs for an individual Place.

“The key thing that we had to do was develop a prioritisation framework,” said Jim, “so that we could take all of those things that we’ve addressed and look at the Place priorities, the National priorities, the ICS objectives, and establish a set of criteria. The position that we want to get to is to be able to say, ‘what are the set of things that we will do, based on the evidence that we’ve collected, that will optimise the investments to turn the dials on outcomes?

“I would summarise it as a focus on outcomes and understanding the evidence for the basis of investment, because we can say for that investment, it’s auditable back to the outcomes that it directly affects.”

At that point, Jim and Adam moved on to accept questions and facilitate discussions from the webinar audience. This section of the webinar can be viewed at 28 minutes on the video below.

You can watch the full webinar here: