The North West London (NWL) ICS latest board meeting shared insights into the developments in the region, including challenges around cyber resilience, digital in primary care, an update on its digital programmes and progress towards integrated neighbourhood teams.
The ICB noted its application for £1.15 million in NHSE Cyber Risk Reduction funding not yet received, the ongoing development of NWL’s cyber strategy with a target completion date of the end of the financial year, continued progress around the London Shared Care Record and optimisation work around its acute provider EPR. Community and mental health trusts are working together on the development of a “common digital strategy”, the report outlines, whilst the “exploitation” of the Federated Data Platform is said to be underway across all of NWL’s acute trusts.
As part of a report prepared by Rob Hurd, chief executive, the board assurance framework highlights strategic risks around the ICS’s resilience and its ability to respond “appropriately, timeously and effectively to foreseeable major risks, events and potential disruptions” including cyber attack, noting a high risk rating.
The ICB shares progress around Emergency Preparedness, Resilience and Response to include the development and implementation of “a robust training and exercising plan” covering monthly training and table top exercises for ICB commanders and “dedicated exercises for system wide participation for areas of identified risk” such as cyber security. It also notes that an ICB business continuity training package has been developed and shared with business continuity leads, whilst a “lessons identified” tracker collects learnings from a range of sources like debriefs and inquests, to target training and exercising to “areas of identified weakness and gaps in resilience”.
The framework also lists controls including investments in antivirus and privileged access management software, investments in detection and response including cyber security dashboards, the adoption of NHS Digital’s “defend as one” approach allowing a trust undergoing cyber attack to draw on support from centralised teams, awareness training for staff, and shared operational capacity planning and prioritisation.
In primary care, the board notes improvements in the number of GP practices with the “translate” functionality switched on within Patchs, with 64 practices reportedly meeting this criteria compared with a target number of 58. However, the board adds issues to its plans, including the rescheduling of NHSE’s Foundation Class procurement framework and the re-procurement of EMIS and SystmOne, now due by March 2027.
Work is underway, it continues, to address latency issues in the feed from EPRs to the Federated Data Platform; on understanding Integrated Neighbourhood Teams’ “requirements for multi-disciplinary record sharing”; and the review of governance around AI by the Acute Provider Collaborative, “to be extended to ICS as a whole by end 2024/25”.
In a summary of Integrated Neighbourhood Teams in NWL, produced by Caroline Farrar, SRO for the programme, the ICB cites the importance of tying in “supporting concepts” such as health literacy and digital literacy to the broader neighbourhood working model, “enabling people to better manage their own health and care needs where possible”. The summary shares patient feedback around the need for a “one-stop shop” for their care needs and the ability to “tell their story once”, focusing on the implications of this for the ICB such as removing duplication between teams, promoting access to shared care records, and making changes to infrastructure and culture “with improved information sharing and effective digital systems”.
Minimum timescales for the completion of various phases of INT rollout cover the deadline of March 2025 for putting “functioning” INTs in place including processes being put in place to measure improvements in patient care and staff wellbeing; March 2026 for Population Health Management to be “fully established” with “full digital interoperability”; March 2027 to meet the target of INT jointly planning its workforce to “deliver integrated care models”; and the ICB setting a date of March 2029 for “INT delivering demonstrable system benefits and outcomes”.
Neighbourhood health and delivering a system-wide approach to population health management
NWL set out its strategic approach for INTs toward the end of last year, focusing on the need for all providers to place the development and support of INTs at the core of their own strategies, and noting the “crucial” enablers that will support effective integrated working, including data, technology and digital enablers such as the shared care record. Each INT is to work through four phases of development, starting with foundations and integrated practice before moving onto population health management with supporting infrastructure, integrated and intelligence-led practice, and finally full delegation for neighbourhood delivery of core offers. The second phase should see population health management established and embedded, with “deep” understanding of the community through data analysis, and interoperable IT systems in place to enable joint care.
NHSE published guidance earlier this month for progressing and delivering neighbourhood health, asking ICBs to plan a neighbourhood health and care model, with an initial focus on people with the most complex health and care needs. It notes the need to develop a consistent, system-wide population health management approach and to “utilise quantitative data and qualitative insights to understand needs and risks for different population cohorts”. It adds how this information should inform the design and delivery of care, and that systems should aim for “improving coordination, personalisation and continuity of care”. Here, it notes the use of a single electronic health and care record that is actively used in real-time, to provide “care coordination functionality between the person or their carer and the wider multi-professional team, working across organisational boundaries.”
One of HTN’s January panel discussions focused on the role of digital in supporting NHS reform – modernising services, shifting from hospital to community, and supporting the move from reactive to proactive care. We welcomed Dawn Greaves, associate director of digital transformation at Leeds Community Healthcare; Ananya Datta, associate director of primary care digital delivery at South East London ICS; and Stuart Stocks, lead enterprise architect with Aire Logic. Panel members shared their insight and experience from a wide range of digital projects, highlighting what worked well and their learnings; how their organisations are currently tackling key challenges such as capacity and demand, and managing waiting lists; and balancing risk with innovation.
