The role of digital in green plans from five integrated care systems

How are integrated care systems going green, and what is the role of digital?

Join us as we explore five ICS green plans to explore the digital sustainable priorities and projects underway across the country

Somerset ICS

Alongside priorities such as leadership and governance, supporting staff to engage with the green plan and deliver sustainable services, and reducing waste through the supply chain, the ICS highlights “decarbonisation through digitisation” as a key focus area in their plan.

“There are many opportunities to cut carbon via the digital transformation agenda”, the plan states, with options including telemedicine, building management systems, better logistics and route planning, ‘gamification’ of carbon reduction measures to improve employee engagement, flexible working, virtual meetings, and digitisation of records. It adds that digitisation is to be treated as a cross-cutting theme for the other activities set out in the plan.

Technology is highlighted as an underpinning principle of the green plan for the role it plays in supporting cohesive services. The document reads: “We will ensure that all partners are pulling in the same direction and ensure compatibility in technology and infrastructure.”

Tracking progress and reporting is also featured in the plan under the priority of leadership and governance, with Somerset setting an ambition for each ICS member to provide a report on the progress they have made on an annual basis, supported by quantitative data from the NHS’s national data collection. This will be compiled into an ICS progress report by the sustainability manager, for presentation to the board.

North East London

Among the targets set out in North East London ICS’s green plan the ICS shares an ambition to identify transformation projects that can be delivered at scale.

As one of their priority areas, they hope that digital transformation will help patients to be seen at the right place in the right time, along with assisting clinicians in making informed decisions about the carbon cost of their care.

North East London go on to share a number of planned actions, beginning with work last year to establish a workstream lead and identify a senior support lead in order to fill their skills and resources gap.

Moving onwards, through 2023 the ICS notes the nationwide aim to have at least 25 percent of outpatient activity delivered remotely; to do this, they will maintain their pandemic-triggered increase in video and telephone outpatient appointments and build upon their Patient Knows Best programme to provide education around the benefits of remote appointments, including reduction of paper and travel. To further reduce the need for travel, the ICS will roll out e-prescribing to trusts and is considering expanding their self cervical smear test programme across the area.

A pilot scheme is planned for primary care teams to gain advice and guidance from acute consultants via phone, to reduce both travel and the waitlist. The ICS also intends to gather learnings around Personal Care Budgets with regards to supplying patients with technology where needed so that they can access remote consultations.

Also in 2023, the ICS is to look at reducing waste and high energy using relating to technology; actions here include a ‘switch off’ campaign in primary care, automatically set computer settings for brightness and sleep, the hosting of a North East London conference on digital and carbon reduction, and focus on ensuring that third party data facilities are using renewable energy. They plan to conduct an ICT lifecycle assessment, include renewable energy in tendering questions for digital solutions, develop an ICT recycling and donation service, and to conduct a staff campaign on low energy settings and carbon footprint data in relation to tech, along with identifying redundant ICT to reduce, remove or recycle as relevant.

Interoperability is also raised; here, the ICS states that it plans to hold an interoperability strategy review to feature carbon reduction solutions, along with aligning software suppliers in health and care services.

The final focus in digital transformation in North East London’s green plan centres around remote working and events. This year, an events guide is to be developed which will include information on how to use the latest digital platforms. Events are to be hosted digitally in the first instance where appropriate, and the ICS also plans to explore how social elements can be included in virtual events.

Joined Up Care Derbyshire

Next we come to the green plan from Joined Up Care Derbyshire, where the sustainable vision includes the ambition to strategically utilise digital innovation.

“To achieve this,” the ICS says, “we plan to collectively use and share digital platforms and applications to increase the efficiency of working practices and care. Overseen by the Derbyshire Digital and Data Board, we plan to roll out applications such as MS Teams, SharePoint, and the Derbyshire Shared Care Record across our trusts”. These actions are planned for 2023; a longer-running ambition until 2025 includes “uniformly monitoring emerging technological approaches and 21 digital innovations.”

Another ambition is for oversight and knowledge of the ICS’s carbon footprint to “drive systemic change through data-led intelligence”. The ICs plans to build a network of trans-departmental figures responsible for investigating, monitoring and collating data on the system’s carbon output. “To support the intervention,” they add, “we will call upon the assistance of our Clinical Support Unit through which the ICS commissions data intelligence services. An ICS-level approach to tracking and targeting carbon hotspots is hoped to offer a considerable improvement to the data currently amalgamated under the banner of NHS Midlands.”

Suffolk and North East Essex ICS

The opportunity for digital transformation raises in Suffolk and North East Essex ICS’s green plan is the chance to develop “a faster, more efficient service that speeds up care pathways, reduces patient anxiety and embraces care closer to home that maximises health benefits and outcomes”.

The ICS acknowledges that by creating a digitally fairer society, they can support wellbeing and help to tackle inequality, and notes that digital can assist them in “increasing the switch to a circular economy – reducing resource consumption, ensuring longevity of digital equipment and ensuring all e-waste is re-used or recycled”.

Digital appears twice in the green plan’s guiding principles, firstly in their intent to maximise digital and hybrid ways to working to reduce travel and secondly through their plans to embed their ICS Digital Strategy into the sustainability programme, “ensuring our staff recognise and embrace digital transformation as an enabler to reduce carbon emissions, improve patient care and optimise system working”.

The ICS highlights the NHSE aim to achieve a minimum of 25 percent initial outpatient appointments, with 65 percent followed up digitally. They pledge to ensure more targeted efforts to “generate good habits” through acceleration of digital models of care, digitising, connecting and transforming services safely and securely.

The ICS plans to follow the Greening Government ICT digital services strategy, “using digital as an enabler to increase transparency and collaboration and use it to increase accountability”. Other key activities include seeking innovative ways to digitally provide appropriate self-care to individuals in their own homes; actively seeking opportunities to exploit remote process automation to reduce inefficient and carbon-generating activities; and to undertake digital carbon challenge-related activity to reduce carbon impacts.

Norfolk and Waveney ICS

Finally, we come to the green plan from Norfolk and Waveney ICS. Here, the ICs states that the success of the green plan “will be underpinned and enabled by modern, efficient digital and data services which support system transformation and sustainability”, adding that alignment of digital approaches to healthcare is expected to significantly support reductions in environmental emissions.

The ICS notes that the demographics across their region are very different, with an urban and much younger population in Norwich in comparison to rural, older areas like North Norfolk, which has poorer digital infrastructure. They acknowledge that “there are some instances when we need to adapt services to meet the needs of each area – and this may have an impact when considering initiatives and approaches to reducing the environmental impact of services and working towards sustainable healthcare.”

Looking at their plans around building sustainable models of care, Norfolk and Waveney state that an ambition is to “investigate ways to expand innovative services providing care closer to home and digitally enabled care, whilst reducing and removing health inequalities.”

Planned actions for the ICS in this area include continuing to support virtual outpatient and primary care appointments, and state that they will ensure that the What Good Looks Like principles are embedded with regards to digital transformation. They also plan to review paper use and identify where further reduction can be made by using digital technology, and also note their plan to promote and embed more efficient use of digital tools across the ICS, to further reduce their digital footprint.

With regards to how they will measure success in this area, Norfolk and Waveney point towards published materials by HMG Sustainable Technology Advice & Reporting, which will be used to footprint their digital services. They note that they will measure the percentage of virtual appointments, and monitor and reduce the volume and cost of electrical and electronic equipment waste along with monitoring and reducing the cost of purchased paper. The ICS will also measure the percentage of reduced email traffic through their transition to more sustainable, online methods of working such as Microsoft Teams, SharePoint and One Drive.