ICSs can build on the headway made on digital during the pandemic but still need to work on some areas such as growing relationships and deciding who leads

The pandemic may have accelerated progress on digital within integrated care systems, but there remain concerns that will have to be resolved in the medium term.

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That is one conclusion of a report on integrated care systems in London, published by The King’s Fund in February. As well as worries about digital inclusion and acknowledgement that digital first solutions won’t be suitable for everyone or anything, the report says clarity is needed over data sharing, and whether information governance issues have been solved, or temporarily side-lined.

Chris Naylor, a co-author of the report and a senior fellow in health policy at The King’s Fund, told HSJ that the timing of the piece of work had been fortuitous. “We spoke to ICS leaders back in January and February of last year, before the pandemic, and that was what the work was going to be based on. But we were also able to speak to them in October and November to get a sense of how the pandemic had moved things on.

“My take-home was that digital was certainly a priority before the pandemic for ICS leaders, but that the pandemic really moved things along and accelerated some aspects of that work. The question is now how to build on that and sustain some of the work that has been done, while also mitigating some of the risks that it’s thrown up.”

There remains a question about what should be led by providers, what should be led by the ICS, what can be led by primary care networks

One of the issues that Mr Naylor identifies is the lack of clarity about where the responsibility for leading on digital should lie within the wider system. “There remains a question about what should be led by providers, what should be led by the ICS, what can be led by primary care networks. The conversation needs to be had locally, but it feels like there’s a really important role at ICS level in relation to infrastructure, information governance, connectivity and so on.”

When it comes to transformation, getting the right people round the table as early as possible is vital, and that includes digital and clinical leads. “They need to be able to build a shared understanding of what is the transformation we’re trying to achieve, and what kind of information structure we need to enable that.”

It’s also important to focus on the human factors. “Yes, there are technological barriers, such as having systems that are capable of talking to each other, but there are solutions available to tackle some of these challenges. Where systems have made bigger progress, it’s where they’ve got trust between all the partners; they’ve got good relationships in the system. They have a shared sense of where they are getting to, and that’s important.”

ICSs must put the basics in place to achieve digital transformation