Digital health and data across the ICS regions in 2024: London

Welcome to the first edition of our new feature series, exploring the current state of play for digital and data across the integrated care system regions.

First up, we’re taking a look at the capital, following our spotlight piece on London from last year which you can find here

We’ve spoken to trusts to get insights into digital programmes that are currently underway, examined data to understand the positioning of London ICSs in key areas, we’ll also be taking a look at strategies from across the capital, and sharing a case study from interoperability experts ReStart.

Digital strategies across the capital

Starting on that point – how many of the five integrated care systems in London have a publicly-available strategy dedicated to digital transformation?

From our research, we identified that the answer is two; South East London ICS has a digital strategy spanning 2021-2025, available to read here. It places focus on several key areas including the development of robust foundations and digital maturity, shared records, real-time information for proactive care, patient empowerment, population health and innovation.

North West London ICS has a digital, data and technology plan with similar focuses, including data sharing and patient engagement as well as integrated care and foundational ICT infrastructure.

South West London ICS does not appear to have a specific digital strategy in place, though there is a section dedicated to digital in its joint forward plan for 2023-2028. North Central London’s population health and integrated care strategy, meanwhile, includes the need to “build from insights” from digital partnerships and data as one of its key principles. Similarly, the interim North East London integrated care strategy includes plans around digital.

Building on its digital plan, North West London ICS also published a strategy for its approach to digital access hubs in August last year, intended to provide an overview of the current picture with regards to digital hubs across the footprint and “inspire and inform aspirant hubs of the future to act as a guide of how to get started with hub working”. Hub development is described as a “priority workstream”, with the strategy noting that NHS England has “taken an interest in North West London” due to “key areas of acceleration… which stand out in comparison with other parts of London”. At the time of publication, there were 12 operational collaborative digital access hubs across the ICS’s footprint, covering an estimated 13.4 million patients and 160 practices. Nine of those hubs are said to focus on supporting practices with online consultations and two on multi-disciplinary team or group consultation support, with one of the hubs refocusing its scope of services.

The strategy points to an “appetite and a will amongst a range of stakeholders of all levels to deliver a greater number and more effective digital access hubs across North West London”, with a development group set up as a “core part” of the ICS’s digital programme. The group brings together hub representatives including operational and clinical leads, individuals from primary care and North West London IT teams, and the programme manager from the NHSE London Digital First team. From discussions within the group, a second group has been set up – the PCN IT Interoperability Group – “convened to identify, prioritise and work through interoperability priorities with the aim of enabling hubs to undertake as many as the same functions as single GP practices as possible”.

Since our last London-focused feature last summer, we have also covered the mental health strategy from South West London ICB, which highlights plans to utilise digital tools and services to meet the needs of local communities and “better co-ordinate digital initiatives across the ICS to ensure a joined-up approach”. 

Additionally, there is the five-year strategy from London Ambulance Service, which places emphasis on modernising estate and infrastructure, investing in new ways of working such as through use of AI and robotic automation, and ensuring that staff have access to the digital tools they need to help them do their jobs.


  • Digital strategies across the capital
  • Do the ICSs have digital representation on their boards?
  • Case study: ReStart’s interoperability experts connect healthcare leaders across London
  • Insights from London trusts
  • Health tech in London: snapshots from the past year
  • Resources from HTN

Do the ICSs have digital representation on their boards?

From the publicly available information, we looked at the make-up of the ICS boards to see which boards have digital representation.

Whilst it’s worth pointing out that some members of the board may have digital backgrounds or skillsets not mentioned on ICB websites, from our research it appears that South East London ICS is alone in having named, specific digital representation on its board in the form of a chief digital information officer. However, North West London’s board does include a non-executive director with a tech-focused background who has gone onto co-found a digital-first healthcare service.

In terms of statistics, NHS websites indicate that there is a total of 102 people sitting on ICS boards within the capital, between South East London (24), North West London (15), North East London (15), North Central London (22) and South West London (26). With digital representation of less than two percent.

On the topic of boards, last September HTN explored the papers from a South West London ICB board meeting which saw discussion around the need to transform services including through improved digital pathways across the ICS.

Case study: ReStart’s interoperability experts connect healthcare leaders across London

Next, let’s take a look at a case study from interoperability supplier ReStart, focusing on their work in the capital.

Epic EPR deployment

Following the success of the pan-London project for the London Care Record (LCR) data integration for Guy’s and St Thomas’ NHS Foundation Trust (GSTT) and South London and Maudsley NHS Foundation Trust (SLAM), ReStart was invited to support GSTT with their work on the largest Epic Electronic Patient Record (EPR) programme in the world.

The ‘Apollo’ EPR has been implemented across three trusts (Guy’s and St Thomas’ NHS Foundation Trust, Royal Brompton & Harefield NHS Foundation Trust and King’s College Hospital NHS Foundation Trust). The solution brings data from hundreds of clinical systems into a single EPR system for over 40,000 staff to access, across multiple hospital and community sites.

The deployment was underpinned by ReStart’s integration, system architecture and data migration tools. The migration of existing data and ongoing integration of system wide data gives staff a complete overview of a patient’s care record, supporting a joined-up approach to care through access to more accurate data, in real-time.

Working with fellow suppliers

Many health and care data integration projects require a collaborative approach from more than one technology supplier. ReStart recognises that working with other IT suppliers, such as InterSystems and Better, delivers more efficient and cost effective results for the NHS. In particular, when supporting an Integrated Care System (ICS), working in partnership enables the best skills combined with the best bits of technology to be harnessed from different suppliers to deliver complex digital solutions.

Recently with InterSystems, ReStart supported the implementation of a new Integration Engine with the migration of 170 interfaces from an incumbent Trust Integration Engine. Working as a collaborative team, ReStart’s data migration experts were able to focus on delivering a stable integration platform to support the existing estate, whilst enabling the rapid development of a new interface.

Working with Better on One London’s Universal Care Plan, over 25,000 care plan updates are now carried out each month as a result of the development work from ReStart through the Qvera integration engine. ReStart also delivers 24/7 support on the data integration and migration work and can now provide a dashboard view for internal IT departments to view activity in real-time.

Integrated care system support for data integration 

Working with the South East London (SEL) ICS, ReStart is involved with a number of complex cross-trust data integration projects including:

  1. Transfer of Care GP Letters – involving deep technical knowledge of APIs and a customised audit process to track the outcome of every letter from source within an EPR out to the GP to action.
  2. Development of a PDF reader and DICOM message integration to support ophthalmic digital processing. ReStart’s experienced staff have years of working with the DICOM standard and enabled a safe and complete electronic workflow to support doctors, nurses and optometrists better manage their patients suffering from diseases of the eye.
  3. Successful integration of a Clinisys ICE GP order comms system to enable GPs to order pathology tests. ReStart developed the bi-directional interfacing to facilitate filtering of patient data from an EPR to an ICE, alongside the exchange of GP orders and results.

ReStart has worked with 49 percent of NHS Trusts, providing 24/7 integration support to 20% of Trusts and currently working in over 50% of ICS’s. ReStart’s team of interoperability experts and solutions connect healthcare leaders across all regions.

Learn more about ReStart.

Insights from London trusts

Dr Gill Gaskin, medical director for digital health at University College London Hospitals NHS Foundation Trust, shared insights into the digital landscape at UCLH.

“It has been five years since UCLH transformed into a digital hospital through implementing Epic, our fully integrated electronic health record,” Gill shared. “As research, technology, treatments, services, and indeed hospital buildings change, our digital healthcare teams continuously work with operational teams to adapt and configure the system to improve what we do for the benefit of patients and staff.

“This year, through new training and adoption communities, we will focus on enabling people to use the system even better across all areas. We want to ensure that everyone can harness the power of a fully integrated electronic health record whether this is in administration, clinical areas, research, or when access information as a patient or carer.”

A particular focus for the trust involves building on its EHR capability to facilitate clinical research studies, for example through a new approach aiming to make research a part of everyday clinical care, whilst reducing research costs and addressing clinical questions that can be difficult to answer through traditional trials. “The approach uses a computer prompt to ask a clinician making an everyday care decision – especially where there is no clear cut wrong or right answer – whether the patient should be randomised into a study or not,” Gill shared. “In one trial, researchers are assessing the feasibility of using computer prompts EHR to ask clinicians deciding on magnesium supplementation whether their patient could be randomised into a study looking at the effectiveness of liberal or restrictive approaches to magnesium supplementation. The prompt will remove the need for manual patient randomisation and consenting – patients will have consented to take part in advance – and the clinician will be able to override the prompt if preferred. This should shed light on how EHR systems can be used to deliver rigorous learning from routine clinical decision making.”

Other initiatives include a digital tool called TrialsAssistant, designed to streamline research recruitment by automatically spotting when a patient meets eligibility criteria; switching to eConsent to allow patients to review and electronically sign consent forms directly on iPads, with the form automatically timestamped and saved into the patient’s records; and improving data access for health researchers through a collaboration between University College London, with use of AI and machine learning.

Additionally, UCLH is developing a piece of software to connect to its EHR with the nationally provided GP Connect system’s API, aiming to make structured information available directly in Epic for patients’ current medications; developing a Digital Innovation Hub to “create a safe space for innovators across UCLH, UCL and third-party collaborators to work effectively together”; and investigating if AI can reduce lung cancer diagnosis times through the LungIMPACT trial, by evaluating AI tech called qXR to see if it can help reduce the time taken to diagnose lung cancer.

We also found out more about the digital work underway at Chelsea and Westminster Hospital NHS Foundation Trust from Mike Wright, innovation business partner at CW Innovation.

“There’s a lot of work happening around artificial intelligence at the moment,” Mike shared, “for example with AI technology that is designed to identify high-risk skin lesions in patients on the urgent cancer pathway. With that tech, images of the lesion can be uploaded into the cloud; the AI then looks at the lesion and deems it to be high-risk (in which case it is expedited for review and the patient may be referred for a biopsy) or low-risk, in which case the lesion might be referred on for a second look by a panel of dermatologists, pending discharge, or they might be reintroduced to the cancer pathway if needed. It helps the patient get seen and treated more quickly if they need it, and of course it’s nervewracking being on a cancer pathway, unsure if your lesion is cancerous or not; so this tech can help patients get their answer more quickly too.” Mike added that the trust has “consistently met national standards for performance over the last five or six years, with the technology helping us to achieve that. Also, that’s against rising rates of referrals – in the last five years, the volume of referrals has increased three-fold.”

Within the ophthalmology department, Chelsea and Westminster Hospital NHS FT is also trying out a voice AI to call patients. “A patient might be getting treated for cataracts – they will be referred to the service, they’ll have their cataract surgery and then ordinarily they would come into the hospital between four to six weeks after surgery for a face-to-face appointment with a nurse. We now have an AI tool that calls the patient and takes them through a conversation. If there is something of concern noted in the patient’s responses, this is flagged up to the nursing team who can then follow up.”

Mike commented on the trust’s use of the Isla image-sharing platform, which has recently been deployed in the breast care service at West Middlesex Hospital. This allows patients to submit images of their wounds and clinicians can perform remote assessments before deciding if the patient needs to come into hospital for an appointment. “It allows the patient to make better use of their time – they might not need to take a day off work to come in to hospital for an appointment, for example, and it also means that the clinical team can focus on the patients whose wounds require more attention.”

Chelsea and Westminster is also utilising e-consenting in surgical pathways, and Mike mentioned the trust’s work with communities, particularly a “very vibrant collaboration with Hounslow Council around digital inclusion and providing community members with digital technologies so that they can access trust services digitally. We are very aware of the risk of exclusion as we move more towards the digital front door approach; we have been working with a number of community groups for several years now to identify people’s experiences, what they like, what they find challenging, what do we need to do differently, and so on.”

Jeffrey Wood, deputy director of ICT at The Princess Alexandra Hospital NHS Trust, provided insight into some of their digital projects and focuses. The Princess Alexandra is working on a new electronic health record implementation, he shared, as well as a patient portal; a virtual receptionist capable of talking in multiple languages including sign language; a 5G private network; key lockers to reduce the burden on teams needing to book out keys; and device lockers for staff to collect and return laptops and other devices 24/7 without needing to wait for ICT to repair them. Additionally, the trust is working on vending machines for consumables to allow staff to quickly get hold of items such as headsets, mice and HDMI cables; multi-provider SIMS in devices for community teams; a real-time location system; and collaborating with the ICS on an elective care hub with outsourcing of pathology.

Immediate priorities over the next 12 months will be improving the end user experience to “put clinicians back in front of patients,” Jeff continued, as well as increasing the use of robotic process automation and artificial intelligence to also assist in this area. Over the next three years, he hopes to see less time “fighting fires and more time spent on innovations”, a dedicated design and development team to be “constantly evolving our use of RPA and AI”, and increased use of wearables for both staff and patients.

There needs to be “large culture change” in order to realise these ambitions, Jeff acknowledged, highlighting a need for “NHSE to get behind the need to support technology across multiple platforms and devices and encourage suppliers to diversify – for example, we recently had an NHSE-procured system set up with all the funding, and it only works on Android but we are an iOS house.”

Where does each place in terms of data from NHSE?

Over recent months, HTN has been exploring the progress made around virtual wards via the data released on a monthly basis from NHS – you can find our most recent coverage here.

So where do the London ICSs place?

According to the most recent figures, from February 2024, North West London ICB has the highest virtual ward capacity in terms of beds, with 614 virtual ward beds available. South East London ICB has the highest virtual ward capacity per 100,000 adults within the GP-registered population however, with 28.5 capacity per 100,000 adults in comparison to North West London’s 25.7. Both ICBs are reportedly delivering a higher virtual ward capacity than England’s national average of 23.2 beds per 100,000, as is South West London with 25.4 beds. However, this does also mean that none of the London ICSs are at present close to meeting NHSE’s target of each ICS having 40 virtual ward beds available per 100,000 adults.

In terms of occupancy, the figures suggest that at the time of data collection North East London had 100 percent occupancy of its virtual ward beds; North Central London had 89.3 percent occupancy; South East London 85.5 percent; South West London 76.7 percent; and North West London 35.7 percent. It’s worth pointing out that NHSE states that the data “should be used with caution”, as it is experimental and therefore still “undergoing evaluation”.

For further insights on virtual wards within the capital, last month we highlighted an update from Barking, Havering and Redbridge University Hospitals NHS Trust regarding the impact of its frailty virtual ward playing a role in helping to keep frail older people out of A&E – click here to read more.

Health tech in London: snapshots from the past year

We’ve covered a range of health tech stories from London over the past months – most recently news of a development for the Universal Care Plan for London, which has seen the ability to co-create and share pain management plans for people with sickle cell disease added to the NHS service, which is designed to support London residents in having care wishes digitally shared with health professionals across the city. In another development for sickle cell care in London, South East London ICS is to distribute £1.5 million in funding to 22 NHS trusts within its footprint for devices designed to automate red blood cell exchanges.

Also in March, we reported that the New Victoria Hospital, a private facility in London, has signed a contract with MEDITECH to provide its web-based electronic health record, Expanse; and Central and North West London NHS Foundation Trust has awarded a contract for digital neurodevelopment assessments with an estimated value of £749,000 to online mental health, autism and ADHD service provider Healios.

In February, we covered the launch of a new digital academy from North London Mental Health Partnership, aiming to enhance the digital capabilities of staff and upskilling with an emphasis on intelligent date use. We noted that three new trusts joined the London Care Record (Tavistock and Portman NHS Foundation Trust, North Middlesex University Hospital NHS Trust and Moorfields Eye Hospital NHS Foundation Trust); and we also looked into findings from a pilot project focused on digital otoscopy, published by South West London ICB.

At the start of the year, we reported on the news that NHS England awarded a contract with a reported value of £98,237.70 to Health Innovation Network for a review of the London region’s virtual ward and remote monitoring programme. More recently, at Rewired, we listened to the Health Innovation Network’s executive director of digital transformation Dr Amanda Begley as she shared some insights into the work underway for this review, including ongoing work in London around  building “in-reach” and navigator roles to support virtual ward referrals. Click here to read more.

Beyond that, top stories from the past year have included London North West University Healthcare NHS Trust going live with its EPR last summer; King’s College London exploring the environmental impacts of AI-enabled health; and North West London ICS launching a tech-enabled programme aiming to tackle disparities in physical health outcomes for people living with severe mental illness.

Resources from HTN

We’ve heard from teams involved in digital projects and programmes from the capital through HTN Now, our live event series; this month, we heard all about digital access e-hubs for online consultations from a team including Aaron Hamilton, senior project manager at Healthcare Centre London GP Federation. Aaron discussed some of the federation’s work, how they got going with proposals with an at-scale delivery model for e-hubs, and more; click here to read.

In December, we welcomed Rebecca Coughlan, therapy manager of outpatient services at Barking, Havering and Redbridge University Hospitals NHS Trust, for a discussion on how the North East London Musculoskeletal Alliance has improved the quality of referrals and reduced its waiting times.

Through HTN Now we’ve also learned about EPMA in mental health, particularly prescribing and administering long-acting injections, with a team from  South West London and St George’s Mental Health NHS Trust joining us to share their experiences.

We’ve recently interviewed two NHS professionals on all things digital within their ICSs – Dr Osman Bhatti, GP and chief clinical information officer at North East London ICB, andClare Gallagher, project manager for social prescribing at North West London ICB.