Radical rule changes would boost NHS recovery, say chiefs

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ICB chiefs give verdict on preferred national policy changes
Broad support for big changes to data and provider governance
No consensus on how to reform GP contract
Plans include squeezing the pay bill and provider consolidation

The vast majority of ICB chiefs believe “drastically reducing data sharing restrictions” would help them achieve their aims, according to HSJ’s survey.

ICB survey 2024 - policies@2x

Most helpful policies - click top left to read

More than 80 per cent of respondents said it would either be helpful or very helpful if data sharing rules were reduced, with those surveyed also backing several other suggested radical shifts in policy.

Health data experts said there were some straightforward ways national policy could help (see box below).

There were 43 responses to the survey across 39 of the total 42 integrated care boards between January and March. We excluded some typically popular but expensive asks, like reforming adult social care funding or big increases in capital, primary care, or pay spending.

Eight of 14 ideas were supported by more than half of respondents (see full answers to this question, left).

Other ideas put forward by ICB CEOs included “more change capacity”; “at least half the size of NHS England nationally”; “greater access to innovation [through] the NHS App”; better health support for female staff; revising the nursing bursary; and “a pay deal for social care — putting them on NHS terms and conditions”.

Another leader said: “Unless there is a new approach to employee relations nothing will really improve sustainably. The junior doctors action needs to be resolved [with] material improvement in pay over an agreed period.”

Barriers

The most commonly chosen barrier to recovery was “too many national asks and objectives”, with 89 per cent saying it was a significant or very significant barrier.

The next most common, at 75 per cent, was the “national GP contract terms/restrictions” (see full answers, right).

ICB survey 2024 - barriers@2x

Barriers: Click top left to open

While this reveals widespread frustration with the GP contract, the survey revealed much less agreement about what to do about it.

Just over half said “replacing primary care networks with ‘neighbourhood’ teams defined by the ICB” would be helpful, while 46 per cent supported “incentives to speed the closure of small GP partnerships and choice to move to NHS trust, large partnership or GP corporate/chain” and 44 per cent backed “phasing out GP partnerships over five years, with partners offered NHS consultant-style contracts”.

Other barriers given by respondents included loss of senior and experienced staff and goodwill; finances and fragility in local authorities and the voluntary sector; and the national dental contract.

But one ICB chair added: “The biggest challenge is the attitudes and beliefs of NHS leaders who are reluctant to change how they operate. There is still too much competitive and protectionist behaviour, an ingrained belief ‘something will turn up’ to rescue the financial situation, [and] inclination to blame someone else.”

How to ease data sharing pain

Some experts argue there are clear ways national policymakers could reduce data sharing restrictions, despite it being a complex area that has often become politically toxic.

Many of them focus on making much more use of data in GP records, for which the 8,000-odd GP practices are the legal “data controller”.

Matthew Swindells, who has worked as a senior informatics director in trusts and nationally, and as an executive at Cerner (now OracleCerner), said a big priority was to make ICBs the joint controllers of GP data alongside practices.

“I don’t understand why we have not done that already,” he said. GPs’ current sole responsibility means “they feel liable for anything which goes wrong” and using it requires sign off from every practice. Whereas if ICBs become the statutory joint controller, they can carry the risk for decisions they make, he said, whether sharing it for operational NHS use or putting it in a secure data environment for clinical improvement research.

Mr Swindells said NHSE’s federated data platform could be made more effective by giving more users access to a greater level of data. At the moment, it is “way too high level and too late” to be updated, he said.

The government could also create an assumption of sharing data across health and social care, enable NHS organisations to match patients to research projects before asking for their consent, tell individuals (via the NHS App) who has accessed their record, and require greater audit reporting on how data has been used and mishandled, he said.

National Data Guardian Nicola Byrne advised pushing on with NHSE’s switch to “secure data environments”. These are data storage and access platforms with high levels of privacy, giving approved users access to data for research and planning.

They were “hopefully a real opportunity to overcome some of these technical barriers to integrate and bring data together and be able to use it in ways that are more helpful”, she said.

“Also, in terms of public trust, I think they offer higher levels of privacy protection as well for the public. I think SDEs are potentially a very useful vehicle to address some of those challenges.”

However, Dr Byrne also urged caution: “It’s really important not to lose sight of what healthcare data is. It’s not simply a tool. It’s really important to remember what it means to people, what it represents to people. It’s the most sensitive information, often, about ourselves.”

She acknowledged there are technical and legal restrictions preventing data flow but added: “Arguably, the biggest restriction… will always be a lack of public confidence.

“It’s really important to just always be thinking, ‘have we learnt the lessons from history?’, because data initiatives — very well intentioned and potentially valuable initiatives — have fallen over when there’s been a lack of public confidence in them.”