Let’s take a look at the role that digital transformation and change take in three recently released strategies from integrated care systems. We’ll explore key areas of focus in the integrated care strategy from Derby and Derbyshire ICS along with Northamptonshire ICS’s five-year forward plan, both released last month, along with Sussex ICS’s ‘plan for our population’, which was published earlier this month.
Data, sharing patient records and interoperability
Derby and Derbyshire ICS highlights digital and data as strategic enablers, “critical to the development of high quality and sustainable integrated care”, and goes on to share some key actions around data sharing.
The deployment of the Derbyshire Shared Care Record is to be expanded to include hospices, care homes, community pharmacies and other commissioned provider services. A new electronic patient record is to be deployed across the ICS’s acute hospitals, “to enable collaborative working, deliver faster care, pathway redesign, reduced clinical risk and population health management”. In addition, the ICS plans to implement a digital social care record for care homes and domiciliary care providers, along with technology to support falls prevention “and other technology evidence to enable citizens to be supported in the place they call home”.
In addition, Derby and Derbyshire shares an ambition to work on digitisation of the wider health and social care economy, to enhance opportunities for future interoperability and data sharing.
Moving on to look at the five-year joint forward plan from Northamptonshire ICB, the strategy states: “Although we have already started to develop and evolve our digital and data solutions based on the needs of our local organisations and the patients and citizens we care for, we recognise there remains inconsistency across our county.” It highlights a “clear need” for shared data, tools and platforms “to enable a unified understanding of our patients and pathways, allowing them “better target change and improvement”.
With this in mind, the ICB states that delivery of the Northamptonshire Care Record is a priority for the first two years of their plan, as is the provision of a single digital front door via the NHS App. Other priorities around interoperability include optimising and integrating community and intermediate care, along with hospital at home and community-based pathways; and improving digital and information services to share information in real-time and maximise utilisation of bed capacity.
Looking to how to improve urgent and emergency care in Northamptonshire, the document shares that “significant progress has been made to develop some of the foundations needed for an integrated urgent care model”, including implementation of a system control centre to monitor urgent care performance, bed capacity and system response. Noting a need to expand on existing developments and bring them together into a single coordinated model, the strategy adds that this model “will be supported by effective digital solutions that enable a real-time system view of current system capacity and the ability to book or transfer care directly and immediately.”
Data sharing within maternity services takes particular focus for Northamptonshire. The ICB states that they will continue to improve collection and recording of maternity and neonatal datasets; ensure that maternity electronic health records enable staff to minimise data entry and enable paper-free working; develop a system-wide business care to procure a new maternity clinical IT system; and use data to identify and inform birthing people and staff when planning care pathways.
Meanwhile, in Sussex ICS, the new ‘plan for our population’ emphasises their ambition to develop a more community-based approach, through development of integrated community teams. For these teams to succeed, the plan notes a need to share information “effectively across teams from multiple organisations in a simple, timely way.” Data-sharing will be key here, with Sussex highlighting how people involved with an individual’s care will be able to share a common view of information and plans so that they can communicate clearly across the integrated community team.
Sussex emphasises the importance of getting the basics right first, with the plan stating a need to “put the right foundation technology, tools, leadership, and capability in place across our system, and in the hands of our population and workforce.” It goes on to describe how the population, partners and communities need to be connected through digital and data “to allow them to play their part in tackling the challenges the system faces and in building trust in how dare informs care”.
The ICS shares a number of key improvement actions over the next five years designed to improve their use of digital and technology; these include co-designing, developing and delivering common digital and data platforms and products by April 2026 “to enable our population, communities, workforce, researchers and innovators to have access to the tools and insights they need.”
Population health management
Expanding on their plans around population health management, Derby and Derbyshire’s strategy highlights how they will embed a data architecture to inform service planning and delivery using this approach, with the aim of creating a holistic view of citizens that takes into account the wider determinants of mental and physical health.
Population health management is described as “a key part of the ‘data-led toolbox’ required to deliver this strategy and embedding PHM as part of a wider shift to data and intelligence-led decision-making, planning and delivery is essential for the successful delivery of our population outcomes.”
Derby and Derbyshire also notes that evaluative capability and capacity are “essential” to help determine success of actions and interventions. In addition, a “vibrant and collaborative research culture and capability is also key”, with the strategy highlighting how this is required to support the development of new knowledge both in medical and technical terms, and also when it comes to wider determinants and prevention.
As such, the strategy shares how a Derbyshire-wide systematic approach to population health management is being developed, along with pilot activity to test different approaches undertaken in four local areas. Learnings from these pilots are to inform next steps, “including the need to incorporate qualitative intelligence and insights, and engage others in checking or adding to the picture provided through PHM data.”
The ICS adds that this approach will draw on experience from all relevant system partners for each key area of focus in their integrated care strategy – starting well, staying well and ageing/dying well.
Looking to Northamptonshire ICB, improving outcomes in population health is highlighted as one of the four main overarching aims of the the strategy.
Another of the ICB’s priorities for the first two years of the new plan is to deliver the Northamptonshire Analytics Reporting Platform, with the ICB highlighting a desire to “leverage the power of data and analytics to redesign health and care pathways”. The document states that the platform allows the ICS to “consistently and reliably segment the Northamptonshire population into different sub-populations”. Through this, the ICB plans to cover whole population segmentation using mutually exclusive groups to understand system performance and compare needs between different geographies; and sub-population segmentation to understand needs at pathway, diagnosis or ‘population of interest’ level, such as Core20PLUS5 groups.
The ICB adds that risk stratification will be used to understand context and enable quantification of risk, to “help us compare areas more accurately, understand the impact of care pathways, and identify need and design services to better meet those needs.”
In addition, Northamptonshire shares plans to work with colleagues in public health and across the integrated care partnership to undertake “a rolling programme” of joint strategic needs assessments targeted at priority areas. “Transparency is key and we will work to ‘democratise’ data, offering direct access to this information using portals and other online tools,” the document states.
At Sussex ICS, the ‘plan for the population’ notes that their overarching aim to connect their population, partners and communities through digital and data will allow allow them to build trust not only in how data informs care, but also in the role data plays in population health management, research, and innovation.
Sussex also highlights how they are looking to improve health inequalities across the region by “providing clinicians and research access to anonymised data about the population.”
Staff empowerment
Derby and Derbyshire ICS emphasise that they will support and develop their workforce as well as their citizens in the use and adoption of digital services.
Northamptonshire ICB’s strategy emphasises an ambition to upskill the workforce in use of digital technologies; implementing a digital skills academy and accreditation programme is laid out as one of their 2023-2025 priorities. Leadership is also raised, with the ICB stating that they are “cultivating a culture that champions digital change, drives collective ownership over digital delivery, and promotes a digital-first mindset”.
Meanwhile, Sussex ICS plans to launch a Digital and Data Science Academy by April 2026; this will be designed to tackle long-term recruitment, development and retention issues.
Supporting patients: self-management versus digital exclusion
In this area, Derby and Derbyshire state an aim to provide digitally-enabled care “using tools and technology to improve citizens knowledge and understanding to take greater control of their health and care.”
“As we push our ‘digital by default’ vision we must ensure an inequity is not created,” Derby and Derbyshire add, highlighting a need to ensure that barriers are acknowledged and tackled including access issues, equipment, broadband connectivity and data packages.
The strategy also references the Joined Up Care Derbyshire engagement platform, which supports citizens to interact with the system by providing a question and answer facility, links to surveys, polls, videos and links to other websites. “It is recognised that this approach may disadvantage digitally excluded individuals,” the strategy notes, “and so other methods are necessary to ensure inclusivity.”
Expanding their digital priorities in this area, Northamptonshire ICB notes that empowerment and access to service is key, with plans to provide more electronic access to personalised records that are “accessible and support the proactive management of wellbeing”.
The ICB goes on to note the importance of safeguarding against digital exclusion through efforts to tackle the elective care backlog; whilst the strategy comments on the usefulness of virtual wards and appointments in providing patients with choice and improving staff communication, it stresses the risk of digital exclusion in this area and the need to manage and prevent this.
Northamptonshire also places emphasis on digital self-management and support, particularly around emotional wellbeing for children and young people. It pledges to invest in digital tools and options for mental health support, resources and participation.
With regards to reaching their citizens, the strategy acknowledges that the ICB has “a suite of communications it can utilise to communicate to target audiences and stakeholders”, including social media and digital channels. It comments: “Work will take place to consistently review and refresh these channels to ensure they continue to cut through and reach the target audiences and communicate with people in the way that most suits their lives and needs.”
One of Sussex ICS’s key aims from their new plan is to simplify digital access to services for their population. The first of the improvement actions highlighted for Sussex in digital and technology is to extend access through the My Health and Care patient app in the NHS App by March 2024.
The ICS shares that it is “one of only three systems nationally chosen to implement E-Meet and Greet. This extra function means that the NHS App can be the portal for planned care, and our patients will be among the first in England to have better care over their elective journey.” Patients who have received a referral for hospital care will be able to track their referral status, receive reminder alerts for appointments, and cancel or rearrange if needed. If surgery is required, patients are provided with extra support to help them wait well.
Going green
Estates is another of Derby and Derbyshire’s key enablers for their overall integrated care strategy. The strategy shares how the ICS plans to “prioritise and maximise the use of best quality estate, which is modern, agile and fit for purpose”; this includes developing “a smaller, better, greener public estate” which is “more efficient, effective and sustainable through optimisation”.
As one of the main priorities of their digital programme, Northamptonshire ICB states that it is investing in digital tools that are “secure and sustainable, delivering health and care services that manage risk and minimise environmental impact.” It notes a range of digital platforms currently in place to support patient care in a sustainable manner, including electronic patient records to reduce paper usage; digital correspondence to reduce postage volumes; growing the proportion of virtual consultations and wards to reduce travel; and supporting distributed working of staff by implementing remote working methods.
Innovation
Derby and Derbyshire’s integrated care strategy acknowledges their work around creating ‘one workforce’, which includes a future ambition to identify “transformative solutions” to support their staff. In line with this, the new strategy acknowledges the need for digital and data innovation to support technology-enabled care pathways to “augment care delivery, efficiency, and citizen/patient/staff experience”.
As Northamptonshire ICS’s priorities around research and innovation, their strategy shares a priority to “promote local adoption and spread of new pathways and technologies to reduce health inequalities”, with an ambition to support the workforce in becoming “clinical entrepreneurs”.
Three of Sussex ICS’s improvement actions take a focus on innovation and trying new things. By March 2024, the ICS says that it will have evaluated and selected a small number of digital innovations that will “best support improvements in discharge”. This will take more patients in the direction of virtual care, with the plan stating that the ICS expects to see more people discharged earlier, where possible, whilst they continue to receive ongoing clinical oversight through digital means.
By April 2026 they aim to have established Centres of Excellence across their providers to enable co-design and innovation with their communities, and by April 2027 they plan to establish Digital Innovation Labs across Sussex.
You can read Derby and Derbyshire ICS’s integrated care strategy here; Northamptonshire ICB’s five-year joint forward plan here; and Sussex’s plan for the population here.
