An HSJ roundtable, in association with The Access Group, discussed how digital technologies might improve integrated care over the next decade.
In association with
Sir John Oldham is currently a strategic adviser to health secretary Wes Streeting but spoke at this event in a personal capacity. He opened the session by summarising three major imperatives, noting that these have been a constant across the 15 years he has worked in this area:
- Human processes and behaviours must change to match the capabilities of technology
- Enabling co-management for people with long-term conditions is key to the NHS’s future productivity
- The AI-empowered individual will upend healthcare
How these imperatives play into the 10-Year Health Plan is still unknown, but the roundtable guests, representing integrated care boards, NHS trusts, suppliers, and local authorities, were not short of ideas.
Panel
- Amanda Begley, director of digital and transformation, Health Innovation Network South London
- Martin Ellis, chief digital information officer, South West London Integrated Care System
- Kelvyn Hipperson, executive chief information officer, Cornwall and Isles of Scilly ICB, Royal Cornwall Hospitals and Cornwall Partnership Trust
- Eileen Jessop, non-executive director, Birmingham and Solihull ICB
- Matthew Kent, chief nursing informatics officer, Oxford Health Foundation Trust
- William Lumb, chief clinical information officer, Lancashire and South Cumbria ICB
- Joe McDonald, medical director, The Access Group
- Sir John Oldham, strategic adviser to the secretary of state
- Karen Taylor, non-executive director, Kent Community Health FT
- Melanie Williams, executive director for adult social care and health, Nottinghamshire County Council
- Dave West, deputy editor, HSJ (roundtable chair)
A “practice first” approach is something that Melanie Williams, executive director for adult social care and health at Nottinghamshire County Council, identifies with.
She encouraged leaders to ask: “What do we need to do to enable [a] person to thrive [and to] better manage their health and social care?” noting the two ideas are closely linked.
But guests were split as to whether technology should be brought in to support optimised processes and pathways, or whether new processes could be designed around the opportunities that new technology affords.
“Too often we’re trying to shove technology in and make it work,” said Martin Ellis, South West London ICS chief digital information officer. “I actually think you need to be able to design the model of care, and then [see] what tech’s required to do that.”
However, Sir John pointed out that “sometimes it is knowing what the technology can do that facilitates your thinking on redesigning the care”.
Kelvyn Hipperson is executive CIO for Cornwall and Isles of Scilly ICB and for Royal Cornwall Hospitals and Cornwall Partnership Trust. He favours an incremental approach to transformation, where technologists must facilitate the here-and-now, but also paint a vision of the possible.
“Transformation has to operate across all time frames,” he said. “The long-term vision… is to keep accumulating those changes.
“As people move forward on that journey, the light bulbs start to come on, and eventually you reach a point where… they grab the idea and actually run off.”
Karen Taylor, non-executive director, Kent Community Health FT, noted there is scope for closer collaboration between social care and healthcare when it comes to innovation. She knows of developments from the social care sector around caring for people in their own homes, data collection, and information-sharing platforms “which healthcare is quite ignorant of, in many ways”.
“So, there is that opportunity in neighbourhoods if you bring the right people together with the right discussion,” she said.
At a time of great upheaval for the NHS, those at the roundtable were keen to identify what kinds of management structure are most appropriate to deliver impactful investment in technology-driven integrated care.
Joe McDonald is The Access Group’s medical director. His experience has led him to believe in a “goldilocks size” for IT projects.
“The magic happens when you’re joining up organisations,” he said. “It’s not at a granular level, because you can’t get any value there. But at a national level, the relationships are too difficult to manage.”
Mr Ellis is concerned about a potentially reduced role for ICBs in the future. “What’s happened in the last two or three years with ICBs is we’ve seen this collaboration around a single budget, around a population, which I fear we’re going to lose,” he said.
Eileen Jessop is a non-executive director at Birmingham and Solihull ICB. She, too, cautioned against allowing individual organisations to drive tech spending.
This meant “taking budgets away and controlling commercial procurements”, which she acknowledged is a “difficult conversation”, but maintained that fragmented IT operations are inefficient and expose the NHS to cyber risk.
Innovative technological solutions to integrated care problems are certainly out there, and the NHS has spent billions on them. But how can the service convert its tech investments into more meaningful outcomes?
A lack of certain types of funding is certainly a blocker, believes Ms Taylor, especially when that funding can be so fragile: “What I feel is missing are the incentives that encourage the healthcare providers… to change ways of working, and adopt technology, and work in partnership… with the population.”
William Lumb, Lancashire and South Cumbria ICB chief clinical information officer, added: “Whole system flow has to be the focus.” He would like to see funds redirected from acute care towards areas such as general practice and mental health, where the bulk of care takes place.
“Let’s put money where the activity happens and support the flow of patients in the system,” he said.
Mr Hipperson thinks technologists have an important role to play in this. He said that meaningful change to processes and behaviours must happen through a partnership of clinicians, technologists, and operations colleagues: “Very often it’s the technologists who see the breadth of need, particularly around end-to-end patient flow.”
Very often it’s the technologists who see the breadth of need, particularly around end-to-end patient flow.
Looking at the patient experience more broadly, Ms Williams suggested more investment in the parts of a patient’s journey where they currently have no interaction with health or care services.
“What I’d want from the 10-Year Plan and neighbourhood health is that proactive and preventive care,” she said.
Evidence of impact is crucial for getting board buy-in, of course – something that Ms Jessop said has been hard to secure.
“I think a lot of boards across the UK pay lip service to [digital], and don’t put enough investment,” she added. “But we also don’t understand what we’re getting out of the investments we are making.
“Birmingham has got a really good implementation of neighbourhood teams, but we need to improve all the reporting upwards to understand how much more we need to invest.”
Acting based on evidence is always a sound policy. But this evidence is lacking in some areas of care where the need is currently high. Amanda Begley, director of digital and transformation, Health Innovation Network South London, gave young people’s mental health as an example.
“We don’t evaluate a technology integrated into a care pathway,” she said. “So we need to get better at how we evaluate .
“We’ve got an emerging market, we’ve got a potential need, but we don’t really have the evaluation of the evidence base.”
In failing to do this, she said, we risk leaving segments of the population behind.
Interoperability and the role of the patient record
Any discussion of integrated care inevitably centres around interoperability between care providers. Add technology to that conversation, and the topic of patient records soon comes up.
Professor McDonald, who has extensive experience working on national and regional health record programmes, thinks records have become “like a bin bag full of stuff”.
“It doesn’t tell anybody what’s going on. We connected up data, but we didn’t connect teams or people,” he said.
Matthew Kent, Oxford Health FT chief nursing informatics officer, believes that any record must pass the “3am test”, in that an on-call clinician must be able to call up information about a patient at short notice and use that information to make quick decisions about their care.
He noted, tongue-in-cheek, that it’s currently possible to use AI tools to find out about what happened at the staff Christmas party, but “I can’t use Copilot to find out a summary of all of that information within my electronic patient record. Not yet.”
While a single patient record could be a godsend – if it could be implemented at all – panellists questioned whether one record would serve the diverse needs of an ICS.
“My personal view, and very simplistic one, is that in the primary care electronic record, you have a summary which gets you to 80 or 90 per cent of what you want,” said Sir John. “And perhaps build on that.”
AI: transformational change agent or time-saver?
Sir John certainly believes that the NHS is already feeling the effects of AI. Not least because patients are turning to it when they cannot find answers from their care providers.
But how deeply transformational can it be?
“AI can only be efficient,” said Dr Lumb. “It will save you money on your HR processes. It will give you five minutes back every appointment. But it will not stop people moving around the system.”
But AI could have a role in reversing the PR problem that tech often has among clinicians, said Mr Kent.
He believes we are “pushing against an open door” when it comes to AI-driven tools – specifically ambient voice technology. His clinical colleagues often view technology deployments as “feeding the machine”, but seeing the immediate and tangible benefits of a system that takes notes for them (for example) could be a light bulb moment.
“Our history of tech in the NHS is really clunky systems that add a lot more work to people’s lives,” said Dr Begley. “If we can get people excited about tech that’s usable and makes a difference to their lives, and we start building interest, passion, and pull for technology, that has got to be the right place to start.”
