Measures including the provision of wider access to shared care records, the development of data sharing standards and new functions in the NHS App are needed to boost the capabilities of England’s integrated care systems (ICSs), according to an official report.
The Department of Health and Social Care (DHSC) has published the independent review by former health secretary Patricia Hewitt on the priorities for ICSs, incorporating a strong emphasis on digital and data issues.
It cites the need for transparent and high quality data as one of the key principles for the success of ICSs, which have been created in recent years as partnerships of NHS bodies, local government, social care providers and voluntary organisations. It also emphasises that interoperable digital systems can underpin big improvements in care, but that there is still a lot to be done to fulfil the potential.
One of the needs reflects a common criticism that so far ICSs have focused largely on the needs of the NHS at the expense of organisations in social care.
To counter this, the review recommends that ICSs should identify digital and data leaders from social care to join the Data Alliance and Partnership Board within NHS England, which has a central role in NHS digitisation. It could then develop into an integrated board to support a shift of effort and resources.
Care records access
The disparity should also be addressed with an urgent development of shared care records to give local authorities, care providers and voluntary, community, faith and social enterprises (VCFSEs) equal access, and expanded beyond individual ICSs to support people treated by a provider in a different system or needing care in another region.
In addition, individuals and, where appropriate, their carers should be able to access as much of their own data as possible within the records and add information on their health and wellbeing.
There should also be efforts to promote data sharing and the interoperability of digital systems – used by GPs, social care providers and VCFSEs – though the development of a standards framework to be adopted by all ICSs.
This would be further supported by the DHSC reforming the Control of Patient Information (COPI) notices to enable more data sharing and planning between local authorities and NHS bodies. The benefits of this have already been shown in a temporary change to enable data sharing to support vulnerable people during the Covid-19 pandemic.
Patients should be given access to more information through further developing the NHS App – making its code open source to approved developers – supported by contributions from a national user group. The app could be linked to a citizen health account – identified as a longer term ambition – with data on an individual from all health and care providers and sitting outside their IT systems.
The account should provide more than electronic patient records and enable people to proactively manage their treatment and care, the review says.
Urgency for skills
It also identifies an urgent need to build digital and data skills in the sector, especially in data science, risk management, actuarial modelling, system engineering and specialist analytics and intelligence. In the short term there is scope to place skilled staff on secondments with other organisations, but longer term ICSs should develop new career routes through local academies, and NHS England should work with trade unions to provide a competitive salaries structure.
The review emphasises the importance of transparent and free flowing data in the system to support analysis and planning, highlighting the potential of the Federated Data Platform (FDP) – currently under development – and the strategic objective of a unifying digital architecture for health and care.
This comes with a series of recommendations on the use of data, including that:
- NHS England DHSC should incentivise the flow and quality of data by taking it from situation reports, the FDP and other sources;
- data required in real time should be taken from automated receipt of summaries and where possible enable site-level analysis;
- data collection should increasingly include outcomes, especially on patient experiences;
- performance data held by NHS England should be available to the ICS and national government;
- and DHSC and NHS England should work with ICS colleagues on a review, to be completed within three months, of existing data collections.
The document also addresses the issue of dealing with the digital systems vendors, saying NHS England should provide support to ICSs, especially the smaller ones, in dealing with large suppliers to ensure accountability and conformity with standards.
This should be accompanied by the establishment of national user groups to work with strategic suppliers, aggregating demand and co-ordinating the need for any changes in systems.
Generational opportunity
Hewitt commented: “Integrated care systems represent the best opportunity in a generation for the urgently needed transformation that we need in our health and care system. Everyone wants them to succeed.
“To fulfil their potential, however, we need not only to back our new structures, but also to change our culture. Everyone needs to change, and everyone needs to play their part.
“My recommendations are intended to help the health and care system make those changes – and I hope that ministers, NHS England and others will feel able to take them forward.”
Publication of the review has come shortly after NHS England produced a guide for ICSs in making their digital and technology choices, indicating it will act as a single central service provider where there is a critical need for scale and visibility at a national level.
