For our penultimate feature, before we turn our attention to London, we’re looking to the South West region. Let’s take a look at what’s happening in digital across South West’s integrated care systems: Bath and North East Somerset, Swindon and Wiltshire; Bristol, North Somerset and South Gloucestershire; Cornwall and the Isles of Scilly; Devon; Dorset; Gloucestershire; and Somerset.
Bath and North East Somerset, Swindon and Wiltshire (BWS) ICS has shared their integrated health and care strategy for 2023-2028, with digital highlighted as a main enabler.
Looking at what the ICS wants to achieve, the strategy places emphasis upon expanding community diagnostic facilities, which will “deliver additional, digitally connected diagnostic capacity, providing all patients with a coordinated set of diagnostic tests in the community, in as few visits as possible, enabling an accurate and fast diagnosis on a range of a clinical pathways.” Initial work, set to take place this year, will focus on deployment of mobile units, and from 2024 here will be a focus on developing additional permanent facilities within the ICS region.
BSW also seeks to embed responsive local specialist services, acknowledging that it can sometimes be hard for citizens to access services, particularly if they live in rural areas or have limited mobility. Advancements in technology are to support the provision of services in local settings, increasing the offer available.
One key commitment made by the ICS focuses on virtual wards, with plans to increase virtual ward capacity over the coming years; another commitment focuses on working to ensure that the system has “routine access to high quality secondary prevention data”, with plans to bring together partners to work on joined-up prevention pathways. The strategy states: “On cardiovascular disease prevention, for example, we will support primary care partners to increase home blood pressure monitoring activity and work with community pharmacy to roll out a Hypertension Case Finding Service.”
Digital transformation also plays a key role in the BSW’s green plan, with a number of commitments laid out: to make best use of technology and data to help reduce carbon emissions, to ensure that ICT and digital services align with the What Good Looks Like framework, and to seek to better understand the ICT carbon footprint and reduce energy requirements of equipment and infrastructure. The plan also sets out some actions, including exploring carbon modelling tools to help quantify the carbon reduction achieved from switching to digital; to baseline current alignment with What Good Looks Like across partners; and to baseline the ICT footprint in line with the HMG Sustainable Technology and Reporting materials across partners.
Towards the end of last year, BSW launched an “anticipatory care digital toolkit“, designed to help healthcare professionals identify the patients likely to receive most benefit from anticipatory care, and to help them deliver care tailored to their needs. The digital toolkit provides advice, case studies and tools on topics such as multi-disciplinary working, interventions and support, and holistic assessments.
Last summer, HTN hosted digital health care consultant David Kwo for a discussion on population health and patient engagement, in which David discussed his work with BSW on their acute hospital alliance programme. He described how the ICS has “a high degree of clinical collaboration across their three trusts” which he called “exemplary”. David went on to share how the ICS engaged a design authority to work across the three trusts which resulted in ten design principles, available to view here.
Bristol, North Somerset and South Gloucester (BNSSG) ICS has recently refreshed its digital strategy for 2023-25. In the strategy, they share the six key aspects of their vision: to embed benefits and opportunities of digital and data in their integrated design process; to have a robust collaborative digital infrastructure to allow frictionless working across settings; to avoid duplication through integration and re-use of systems, services and more; to support patient experience and staff working through digital functionality; to ensure that digital-first channels are available for citizens; and to use the integrated data-sharing and planning platform to make the best decisions for people and the system.
The document sets out how digital teams from across the system have come together as a single group and have created three priorities: to design a digitally enhanced ICS, to develop digitally empowered citizens, and to deliver digitally enabled care. Actions to support these priorities include driving digital and data integration opportunities; establishing population health platform and tools; embedding collaboration and shared system development; improving information sharing between citizens and providers; focusing on citizen engagement and digital inclusion; providing more digital channels and services; ensuring that pathways work across organisations boundaries; and improving digital infrastructure and security through single sign-on and common cyber standards.
The ICB has also provided a set of digital principles, aiming to establish a clear way of working as a system. The principles state that the ICB will always act in the best interests of the system as a whole, that it will be an independent arbiter to manage competing demands, and that it will dedicate leadership and resources to support system partners. In addition, it will foster a culture of collaboration, empower collective decision-making, and define success at a system level, sharing performance data to better understand impact.
Looking to examples of work across Bristol, North Somerset and South Gloucestershire, last month we covered how the ICS is introducing ‘intelligent care traffic control centres’ in order to view demand, capacity and predict future need across the system. The introduction is designed to improve operational planning through use of predictive analytics tools, with data to be pulled in from ambulance services, NHS 111, social care, acute providers, virtual wards, GP and mental health providers. The ICS also aims to forecast patient flow, patient harm, and scenario planning to improve operational decision-making and urgent and emergency care performance across the region.
In addition, at the end of 2022, the ICS gave notice of its plans to procure a shared care record this year with the scope of the project to include a platform or portal to enable 12-15,000 health and care professionals to access information according to their job role; supporting infrastructure and software services including an integration engine and data store; and a patient matching solution.
Next up, we’re looking to the south coast to explore digital across Cornwall and the Isles of Scilly.
In their integrated care strategy, the ICS notes that one of the key pieces of feedback they have received from citizens in the area is the need to balance digital with face-to-face support, to combat digital exclusion and to combine interventions to create a balanced system.
They place emphasis on assistive technology, noting: “Over time as we build our knowledge of what our people need, we will seek to commission support from new providers for assistive technology, building this into personalised care plans and evidencing how target care pathways have been adapted to involve personalised care.” This is to include reducing barriers to accessing digital technology, particularly for older adults in the region.
Looking at the ICS’s work on digital enablement in more detail, the strategy highlights the need for effective data and information sharing to improve outcomes. One ambition is to embed a population health management approach to better inform the approach to prevention and the understanding of how inequalities impact outcomes; another is to further implement virtual wards; and another is to more effectively share data across multi-agency partners for safeguarding.
Key priorities in terms of their digital strategy include procuring a new ‘anchor’ EPR to sit alongside the newly-implemented Shared Care Record, which will provide the foundation for better information-sharing. In addition, the ICS prioritises the need to conduct an infrastructure audit across its organisations and progress relevant improvement programmes, and to meet the training needs required to support staff with their own digital skills by developing a digital literacy programme.
In January we shared how Cornwall Partnership NHS Foundation Trust is supporting local residents to access an online peer-to-peer support community with moderation from licensed and registered mental health practitioners. The initiative provides residents with 24/7 support, 365 days a year.
In addition, in December, we shared insight from Royal Cornwall Hospitals NHS Trust’s transformation lead Helen Williams on their approach to validating waiting lists. Helen shared how the trust has implemented a digital patient hub with a waiting list validation module. “We could design the responses for the patients so we’ve kept it as simple as possible. We ask if they still want the appointment, yes or no, and also ask if they would consider travelling out of their county, to try and capture those patients who would consider this and flag it as an opportunity if it becomes available. Patients can state that they no longer want the appointment because either symptoms have been resolved or they have been seen elsewhere, and the final option is that they can tell us if they want to speak to somebody. That triggers the system to tell the team to contact the patient to discuss that in more detail with them.”
Digital plays a key role in two of One Devon ICS’s overarching priorities, as set out in their integrated care strategy. Firstly, looking at tackling inequalities in outcomes, experience and access, the ICS states that by 2028, they plan to have increased the number of people who can access and use digital technology and improve access to dentistry, pharmacy, optometry and primary care.
Another priority is to enhance productivity and value for money; by 2028, they aim to provide a joined-up, standardised digital infrastructure. “People in Devon will have to tell their story only once,” the strategy states, “and clinicians will have access to the information they need when they need it, through a shared digital system across health and care.”
As part of the strategy, One Devon has agreed five essential supporting factors; digital transformation is one of them, with the strategy emphasising the need for “standardised and unified digital infrastructure with a common procurement, so that all health and care organisations are connected, with standard systems for frontline staff to use.” Another factor focuses on workforce, with the document noting that digital technology will be needed to support innovation and transformation across all services. In addition, the strategy points to the importance of data and information sharing, highlighting how primary care, social care, mental health and acute hospitals should have access to a single source of truth.
In terms of digital activity from the area, last year we covered how Torbay and South Devon NHS Foundation Trust digitised their maternity pathway from antenatal through to postnatal care, with all medical and nursing notes are captured in a single record, including advanced functionality to support staff with the management of more complex pregnancies. Tracy Moss, head of strategic systems’ software development, said that the solution “is expected to bring a wealth of clinical as well as efficiency benefits for our maternity teams and the wider organisation” and added that the trust would like to continue with digitisation efforts “both within our maternity unit and across our wider Torbay and South Devon organisation.”
We also heard how Devon Partnership NHS Trust introduced a new dataset providing psychological therapy data through the Medical Interoperability Gateway platform; the dataset provides real-time access to information held within psychological therapy services and aims to form a holistic understanding of a patient’s needs.
Moving onto Dorset ICS, there’s plenty of information on digital priorities and activities to be found on their website. The ICS places digital focus on self-care, with digital tools available for long-term condition management, their health and care app library, self-diagnosis and screening, remote monitoring and virtual wards. The digital team states that it is their mission to “empower self-care and enable the people of Dorset to confidently manage their health, mental health, wellbeing and long-term conditions.”
In order to achieve this, ICS provides digital tools for supporting COPD, asthma, diabetes, heart problems and arthritis; a range of resources are available including educational sources, self-management plans, videos, symptom tracking diaries, action plans, individualised treatment plans and fitness and nutrition programmes.
Their online health and care app library has been developed by clinicians and content is quality checked, with the ICS stating that the library “gives you unlimited access to thousands of independent app reviews across all health conditions, each of which includes a breakdown of key assessment criteria relating to clinical assurance, data privacy and user experience.”
As part of their efforts to support remote monitoring, Dorset has developed digital patient guides and supplies videos demonstrating how to use tools, supporting patients to understand what they should be doing and the benefits they will unlock from doing so.
TTheir virtual wards programme also has a dedicated section of the website, through which the ICS describes what virtual wards are and what they can do and provides onboarding information along with a user guide and more videos to guide patients and support their understanding.
There has been lots of news coming from Dorset ICS in recent months; in March, we shared how the ICS had launched a discovery phase to review its current integration and interoperability landscape, with an aim to redesign its data architecture.
In February, we shared the news that University Hospitals Dorset is using artificial intelligence technology to build facilities at the new Royal Bournemouth Hospital, with the technology analysing data captured at the site through helmet-mounted 360-degree cameras. The AI then creates progress reports supported by the visuals, to develop accurate and in-depth analysis for stakeholders. Steve Killen, transformation director, commented that the project “is a great example of how we’re using cutting edge technology to help provide the best value for money for the taxpayer. It provides evidence-based analysis in real time, reassuring us that the healthcare standards on the BEACH building project are being met.”
In another area, January brought the news that Dorset HealthCare University NHS Foundation Trust was expanding its text service to provide quick advice for carers and parents through a confidential text messaging service, which aims to provide guidance and advice around the child or young person’s health or development on a range of issues including sleep, mental health, healthy eating and bullying.
Here at HTN we will soon be sharing an interview with Sarah Chessell, lead for the Dorset ICS Innovation Hub and head of innovation at University Hospitals Dorset NHS Foundation Trust, so keep an eye out for that in the coming weeks.
Leaders in the South West face a complex set of issues, many of which are unique to the area. With a large rural, disconnected region, recruiting and retaining staff is increasingly difficult.
As an ICS leader, you need a deeper level of insight into what staff want and how they’re currently working. Data-driven decisions can support both service delivery and long-term planning – and Lantum is uniquely placed to meet both these demands across ICSs.
Delivering for ICSs across the region
Flexibility is an essential component of robust healthcare coverage, but it needs to be directed the right way from the top down.
With Lantum, leaders at all levels nurture relationships between locums and practices, whether it’s individual sites or across a PCN. This removes regional variations that could see certain practices significantly under-resourced compared to others.
Leaders are able to access real-time locum usage data and use this information to help shape future budgets. This boosts patient care outcomes while also improving job satisfaction for permanent staff and locums.
Knowing how and where staff are working is the first step to creating an ICS-wide strategy that evolves with changing patient needs.
Example: Using Lantum to plan more effectively for the future
An ageing population means that the NHS has an ever-increasing demand for more nursing staff. Flexible staff pools can be tailored to any clinical need, and having the flexibility to make nursing recruitment a priority in your ICS is invaluable when responding to patient needs. Plus, you’ll also get insights that help you improve engagement and retention among existing staff, reducing the number of skilled professionals that leave your ICS for good.
While those working in any individual practice will be aware of what’s needed, they can be disconnected from decision-makers. Lantum bridges the gap and ensures when a skill is needed, it’s identified and sourced quickly and efficiently.
Making a difference for Our Dorset ICS
Our Dorset ICS, one of the first to join Lantum’s Connected SchedulingTM platform, faced challenges with mobilising its workforce across multiple organisations and employers. Different processes and practices presented barriers to entry, while disconnects in onboarding approaches slowed things down.
They knew an off-the-shelf approach wouldn’t work. After partnering with Lantum, Our Dorset ICS achieved an impressive 90% shift fill rate in the first month of operation. To date, 100+ organisations and 350+ staff have been vetted and onboarded across the ICS.
Bath and North East Somerset, Swindon, and Wiltshire ICB are currently collaborating with Lantum to achieve similar improvements. Innovations delivered through the Connected SchedulingTM platform make Lantum a full-service solution, not another locum agency. Lantum’s platform gives leaders greater insight, staff more career mobility, and practices easier access to the people they need.
Lantum also covers rota management and clinical governance through an intuitive central platform. The ability to make smarter strategic choices benefits everyone involved in the healthcare system. Most of all, it benefits the patients whose quality of life depends on decisions which are often made many miles away from their local practice.
Lantum adapts seamlessly to different settings
The South West is a combination of several mid-size cities, many isolated rural areas, coastal regions and sparsely populated towns. Combined with a rapidly ageing population, this means the needs of the communities are ever-changing.
Leaders can struggle to see the fine details on the ground without losing sight of the big picture. This is a common issue for anyone in charge of a large organisation, but one which can have a significant impact on overall delivery.
Lantum supports ICSs in the South West with:
Lantum’s award-winning Connected SchedulingTM approach boosts engagement, morale and staff retention all at the same time. It allows leaders like you to see how and where your staff are working at a glance, which is crucial to ensure your ICS can adapt to new pressures.
Lantum currently works with 18 ICSs, 300+ PCNs and 1-in-2 GP practices across England to connect healthcare leaders with their workforce.
Gloucestershire ICS published their interim integrated care strategy in December. As a key ambition, the document states that in five years’ time the ICS aims to have “the required analytical and digital architecture, data assets, tools and capabilities across the system to embed population health management, quality improvement and evaluation as business as usual across the system.”
Expanding on this further, the ICS says that it is “determined to harness [digital’s] potential to improve and join up care for our population”, noting that “system partners have embraced new technologies faster, and adapted to provide support in different ways, to meet the needs of local people” and that their digital approach “seeks to provide simplicity for every citizen when connecting to health and care services across the county.” Delivery of digitally-enabled services will be underpinned by a Data and Digital Transformation Plan.
The strategy acknowledges the challenge of digital exclusion and states that inclusivity was a key area highlighted during engagement with partners across the area. “We will invest in a digitally inclusive community, ensuring equal access and connectivity to digital solutions,” the ICS pledges. It commits to ensuring that solutions are simple to use for citizens, and that digital exclusion in the area will be addressed, especially among vulnerable groups. “Supporting our digital journey we will have in place the necessary infrastructure, robust governance standards, cyber security and services to deliver safe, modern health and care services,” the strategy adds. “Data capture and linkage will help us plan our resources and support clinical decision making. Through this we will deliver inclusive services, reducing variation and enhancing safety within our ICS.”
Other key areas of focus include trialling and identifying new digital technology to solve issues, along with using analytics and technological opportunities to innovate.
“Our digital approach seeks to address these challenges and opportunities whilst supporting our net zero ambitions across the county and providing a digital environment that encourages research and lifelong learning,” Gloucestershire states. “We aim to strengthen our integration with partner organisations, local authority, and the voluntary sector to use digital enablers to better support citizens in their homes as well as in our care facilities.”
With regards to digital activity across the region, the integrated care strategy points out that an estimated 54 percent of adults in Gloucestershire now have access to the NHS App to support them in self-management – a figure which has “increased significantly” since the pandemic.
HTN also covered digital progress made in the optometry space, with a system launched across Gloucestershire to enable community optometrists can access a patient’s eye health information and images through a single database. Scott Vallance, ophthalmic imaging manager at Gloucestershire Hospitals NHS Foundation Trust, said: “By joining up a patient’s full eye health history in this way we are already seeing better quality referrals to hospital services. The ability to access results in real-time will help to prevent any delays with getting patients the right care and access to the appropriate service.”
Last but not least, we come to Somerset ICS. Somerset is currently in the process of developing a new digital, data and inclusion strategy which will be based on national, regional and local requirements.
On its website, the ICS shares a wealth of information about its digital work. Emphasis is placed on digitally accessing primary care through Digital First Primary Care (GP Online Services). The ICS promotes the benefits of accessing general practice services online to encourage citizens to get involved, sharing a patient’s story in video format and providing information on how to get involved if citizens are digitally excluded. Here, it points to public libraries or SPARK Somerset, where an IT programme can offer a device loan scheme with referral made by a healthcare professional. The ICS also shares information about computer training courses at local libraries, again highlighting the benefits and signposting citizens to more information.
Further practical work on digital inclusion can be found through Somerset’s digital outreach team; their purpose is to support culture change for GP practices to think more digitally, to educate staff and patients on use of digital tools and equipment, to help improve local information-sharing and digital literacy, and to link together resources and learning, ultimately aiming to support “a consistent message countywide”.
Four primary care networks across the area are using AI to generate a score for each patient registered at a practice, which indicates how complex their health needs are. This score can then be used to highlight those who may be at risk of declining health to the point of requiring hospitalisation. The ICS notes that the tool is available to all PCNs should they wish to adopt it.
Another key area of focus is the Somerset Apps Library, which the ICS describes as providing “a safe place for the public and professionals to find apps which are clinically safe and secure.”
In addition, Somerset runs a Digital People’s Champion Group, made up of members of the public interested in the ICS’s digital work. The group meets “several times a year to discuss new innovations and online services”, Somerset says, and also works closely with health and care professionals to help enable interoperability and promote record-sharing across the system.