Reflections on Integrated Care Systems: How do we Deliver on the Promises of Integrated Care?

At this year's HETT North, one of the standout sessions was 'Reflections on Integrated Care Systems: How do We Deliver on the Promises of Integrated Care?'. Led by Shanil Mantri, CCIO and Clinical Safety Officer at NHS Bath & Somerset, Swindon and Wiltshire ICB, the discussion delved into key challenges facing integrated care, including digital readiness, the role of the voluntary sector, and the imperative for data sharing. Exploring topics such as language standardisation and the inclusive use of language within digital frameworks, alongside the integration of digital tools in community settings, the panel underscored the necessity for a cultural shift and collaborative efforts to propel healthcare transformation forward. 

Joining Shanil were esteemed experts: 

• Kirstie Watson, Director of Digital, Integrated Care Northamptonshire 
• Will Goodwin, Assistant Director, Digital Maturity - NHS Transformation Directorate, NHS England 
• Masood Ahmed, Non-Executive Director & Board Trustee, Coventry and Warwickshire Partnership NHS Trust & GOSH 
• Tracy Hopkins, CEO & Chair, Citizens Advice Blackpool & Lancashire & South Cumbria VCFSE Alliance 

The biggest challenges facing the ICS 

The first point of discussion centred around what each of the panelists saw as the biggest challenges facing integrated care systems. Will Goodwin discussed the significance of the recent Digital Maturity Assessment, which assessed all ICSs and secondary care providers, fostering discussions and collaboration between ICSs and their provider organisations. By utilising the DMA as a catalyst, it became apparent that ICSs were slightly behind providers in terms of digital maturity. The key takeaway was the potential for ICSs to utilise this data to enhance their capabilities, thereby elevating DMA scores and facilitating the advancement of their digital strategies. 

Kirstie Watson raised another significant challenge concerning the potential downsizing of ICBs after their establishment. This move could entail streamlining already lean teams, which might impact capacity to implement transformational initiatives on a large scale. 

Tracy Hopkins emphasised the importance of harnessing the resources available in the voluntary sector and optimising the utilisation of community services as we progress with integrated health and care. While the voluntary sector provides numerous essential services, there is currently an underutilisation of these services within ICSs, hindering the delivery of optimal care to individuals. 

Masood Ahmed elaborated further on the transition from an era marked by competition, budget management, and performance oversight to the current landscape shaped by a new health and care act. While this act promotes the idea of unified teamwork, the necessary structures to support such collaboration are lacking. There is a concern that although the vision prioritises patient-centered collaboration at a systemic level, the essential elements of governance and accountability remain elusive. The introduction of the new act has left many in a situation where they are constructing plans while simultaneously implementing them, lacking clarity on the way forward. 

Nationally, those ICBs operating in a more cohesive manner are often the ones that have embraced a collaborative approach over several years. Conversely, others struggle due to a lack of such collaboration. Until clear mechanisms for governance and accountability are established, the question of how effective collaboration can be achieved remains unanswered. 

How can the third sector be brought into the conversation? 

The conversation transitioned to exploring how ICSs can effectively engage with the third sector. Tracy emphasised that the perspective offered by the voluntary sector from an external viewpoint brings valuable insights. However, there are challenges in fully integrating their contributions, as they often struggle to penetrate the operational dynamics. Often despite being told they are equal partners, the actual delivery of services hinges significantly on the relationships with commissioners. 

Tracy also underscored the crucial role the voluntary sector plays in addressing major challenges within health and care. However, she emphasised the necessity for the ICB to proactively mobilise these efforts to drive impactful outcomes. 

Masood provided insights from his tenure as Chief Medical Officer at NHS Black Country & West Birmingham ICB. Being the second most deprived system in England, the Black Country faced challenges during the COVID-19 pandemic, particularly in encouraging community vaccination. Recognising the importance of collaboration with the voluntary sector, given its deep roots within local communities, they embarked on a concerted effort. 

By engaging with community partners, they gained invaluable insights that would have otherwise remained inaccessible. This collaborative approach significantly enhanced the success of the vaccination program, demonstrating the power of community engagement in overcoming healthcare challenges. 

Barriers to bringing the voluntary sector into the conversation 

Shanil then highlighted one of the challenges confronting the system: the vast array of voluntary organisations, each operating at different levels of maturity and size. How can the voluntary sector come together to work in a more unified way? 

Tracy responded by emphasising the necessity of diversity in mobilising and understanding community needs. She noted that NHS partners often gravitate towards the same organisations within the sector, which can undermine their efforts to commission and collaborate with the most suitable entities. In line with the long-term plan, there's a focus on restructuring to ensure that in every area, there's an alliance serving as the leadership and voice of the sector. This approach aims to consolidate the sector's representation across various forums and groups. 

Will NHS England look at the third sector in terms of the Digital Maturity Assessment? 

Will discussed how this is something the DMA looked at last year, however as the voluntary sector is such a diverse group it was challenging to measure this correctly. This year, they aim to address this by involving more of the third sector in these assessments. They will explore how to utilise the digital capabilities of organisations commissioning services to address challenges faced by sectors like charity groups, providing them with necessary tools. 

He noted that digital conversations often foster collaboration by addressing various organisational challenges. Behind the scenes, organizations are finding ways to support each other, leading to a realisation of mutual assistance in other areas. The key question remains: How can we create a holistic view across the system and establish interconnections?  

"It's not thinking about one part of the system, it’s thinking about that whole pathway approach, and when you look at it as a pathway approach and how digital can enable each part of the pathway, it then creates the conversations between the people." 

Is there a parity of esteem across the whole ICS? 

Kirstie emphasised that the key to achieving a balanced level of digital maturity across the ICS is to take action. Some of the lack of interoperability may be that data sharing may be more rudimentary and may use different tools for different providers, that without initiating this journey, progress would be impossible. 

Furthermore, Kirstie discussed the varied language used by different sectors and stakeholders within the system to address similar concepts, such as citizen, patient, and people. She mentioned a shift in the framework towards centering people instead of citizens, driven by input from the social care and third sectors, as the original language wasn't sufficiently inclusive. 

In contrast, Masood countered these arguments by suggesting that prioritisation plays a significant role. He cautioned against becoming overly fixated on linguistic details, as it might divert attention from other key barriers. Masood stressed the importance of fostering a culture of collaboration and effective leadership, highlighting the need for a system-wide approach, especially given the disproportionate focus on acute providers in the DMA. 

Masood further discussed how the Black Country, as a system, took proactive steps by appointing a primary care CCIO, which facilitated future improvements. He noted that while technology solutions abound, the challenge lies in structuring approaches to effectively leverage them, leading to a fragmented approach. He underscored the importance of understanding the system-level perspective and moving away from organisational-centric thinking. 

Instead of advocating for standardised language across systems, Masood suggested embracing the diverse terminology used within different contexts. He argued that each term holds significance within its respective domain, advocating for a nuanced understanding of why different language choices are made. 

Find out more about Integrated Care at HETT Show  

Listen to the session in full below to hear further discussion points and information from the panel at HETT North. Or join us on 24th and 25th September at ExCeL London where there will be further discussion around integrated care and what this could look like in the future.  

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