Integrated Care Systems (ICS) have been talked about for many years in the UK health system. Whether in their previous incarnations such as sustainability and transformation partnerships, vanguards or new models of care. The evolutionary road to ICSs has been indeed long, having only come into formal existence on 1 July 2022.
Yet, while we are still relatively in the early stages of the ICS journey, systems are already making substantial progress in many areas of the UK, and ‘beginning to make a difference’ as highlighted in the many examples detailed in the Hewitt Review.
Today, there are 42 ICS', and within these associated integrated care boards (ICBs) and integrated care partnerships (ICPs). Tasked with planning and funding health and care services across a given footprint, ICSs and their components have been designed to solve a myriad of problems.
From being the proverbial ‘silver bullet’ for improving population health, through to reducing health inequalities, variation in outcomes and fostering greater collaboration among services. ICS must also drive value for money and system-wide efficiency while managing their own unique set of circumstances, scale and scope, alongside different configurations of local services, data and patient demographics.
There are big ambitions for ICS'. But then, the healthcare system is facing enormous challenges with unprecedented demand, a growing ageing population and finite clinical capacity.
The ‘digital transformation opportunity’
If ICSs are to be the delivery mechanism for the ‘healthcare of the future’, then digital certainly might be called a key enabler, or part of the ‘secret sauce’ in the recipe as it were alongside system collaboration and partnership.
“Digital is a fundamental enabler of the overall ICS ambition and effective collective leadership of digital opportunities at a board level and at a system level will be a key driver of success for ICBs and ICSs.” - NHS Providers, Supporting ICS leaders to harness the potential of the digital agenda
Indeed, herein lies a vision for a ‘digitally-enabled ICS’, what some have termed ‘a digital transformation opportunity’, some core elements of which include connected data at scale, interoperability and shared care records. While these will require much work over the long term, there are some areas where digital technology can help deliver some quick wins for ICSs and ICBs, here and now.
In this Livi short report, we take a look at 4 key areas.
1: Staff mobility and capacity planning
Ask anyone working within the NHS at present, the single biggest challenge facing the system and their answer would more than likely be related to workforce. Capacity across health and care services has never been as stretched. Enter ICSs and ICBs which have a key role to play in bridging these capacity gaps across organisational boundaries.
“The goal is ubiquitous digital capabilities across the system, consolidation of services and eventually the frictionless movement of staff, all of which will accelerate the scale of innovation.” - NHS Providers, Building a digital strategy. Understand the system context
This vision for a ‘frictionless movement of staff’ across geographies is not only a vital part of an integrated care system, but a necessity for the future of health and care. That movement can apply to the clinical workforce thanks to the borderless nature of digital technology. While automation can help to alleviate administrative burden, streamline processes and free time for clinical staff.
Examples of success in this regard and different digital approaches are already beginning to emerge from ICSs. In a recent piece published by the NHS Confederation, one system shared how they were using digital tools.
“Digital is already playing an important role as we attempt to navigate staff vacancies and support our existing healthcare professionals whilst they continue to care for our population. Digital can create efficiencies which can ease administrative workload of overburdened clinical staff and would allow our staff to prioritise patient care, improving conditions for both our front-line workers, and the experience of those they care for.”
How Livi can help: Livi is working with a number of ICB, PCNs, federations and large practice partners to deliver border-spanning digital clinical resource and administrative support at scale.
We give our partners the capability to deploy capacity around the country at speed where and at what times it is needed most. And where services experience fluctuation in demand, we provide the tools to plan for supply shortages in a given footprint.
2: Inequalities and access
It’s no secret that depending on where you live in the UK, you will experience variation in access to health and care services. In primary care for example, there are fewer GPs per head in the most deprived localities.
Where patients might face challenges obtaining an appointment, or where the nearest practice or health centre may be far away, digital consultations can provide an additional means of access.
Digital can also enable clinical resource to be targeted in underserved areas and equip care providers with the necessary capabilities to respond to the specific needs of their footprint.
And in areas where digital exclusion is more prevalent, digital appointments can conversely free capacity for patients who do not use digital services.
"Some people will never use digital services themselves directly but will benefit from others using digital services and freeing resources to help them." - The Future of Healthcare policy paper
How Livi can help: We work to understand specific access challenges at a local level, and have a track record in building resilience in areas with a low GP-to-patient ratio.
Indeed, data from our services shows that Livi serves more patients from economic areas of deprivation in each of the 12 regions in the UK. And taking just one of our services as an example, 75% of Livi users come from the 50% least privileged areas.*
3: Care navigation
If primary care is the ‘front door’ or first point of access by which individuals access care within the UK, then the humble GP practice website is the ‘digital front door’. These ‘digital doors’ have a fundamental role to play in joining up services across a footprint, and with it, supporting delivery of the right care at the right time.
Fragmented experiences across health and care websites can make services difficult to find and locate which can lead to individuals entering care settings inappropriate for their needs.
Digital journeys must reflect ICS partnerships and deliver joined up health and care experiences. This ‘digital seamlessness’ can also facilitate signposting to wider services including mental health, physiotherapy and local welfare assistance schemes for example.
When designed in an accessible, user-friendly and compliant way, websites can encourage patients to self-serve and take ownership of their care pathways. This can result in reduced telephone calls, or in some cases unnecessary physical visits, and help to alleviate pressure on resources across a given system.
How Livi can help: Livi’s websites platform is based on NHS best practice and Digital Service Manual guidelines, and offers a seamless experience in not only look, feel but also functionality. This platform can be rolled out across multiple sites in an integrated care system or primary care network, ensuring consistency of content as well as signposting across a given region. System partners can also roll out content updates for multiple sites in a single click.
Our websites help patients find services they need with nearly half of site visitors going on to either use an online service, self-serve or contact the practice online. While 1 in 5 patients who go to book appointments online visit a signposting page for an alternative service.
4: Chronic condition management
One of the primary focuses of ICSs is of course the prevention and management of long-term conditions (LTCs). There are an estimated 26 million people in the UK living with a chronic illness. With ongoing, complex needs, LTC patients are said to account for 50% of all GP appointments and 70% of hospital bed occupancy. And 10 million individuals are living with two or more chronic conditions.
“People are living longer with multiple, complex, long-term conditions and increasingly require long‑term support from many different services and professionals. As a consequence, people too often receive fragmented care from services that are not effectively co-ordinated around their needs.” - The King’s Fund, Integrated Care Systems Explained
A range of digital solutions have been increasingly used for remote management of LTC patients in recent times. One application being digital clinical questionnaires to support periodic review of patients. While digital video meetings are providing platforms for clinicians and patients to interact and remotely monitor conditions outside of a hospital or doctor’s surgery in ‘Hospital at home’ initiatives and virtual wards.
Taking chronic obstructive pulmonary disease (COPD) as an example, some programmes have reportedly reduced readmissions by 26% in some instances, releasing efficiencies, clinical capacity and hospital beds. While examples shared in the Hewitt Review include the utilisation of data to support upstream intervention in at-risk patients groups in care homes.
Other successful digital use cases have seen the integration of a range of internet-enabled devices within homes with sensors, monitors and GPS trackers used to track data on vital signs, as well as environmental and behavioural metrics to build a holistic picture of the individual. Through a combination of machine learning and data analysis, these tools help to predict and alert a clinical monitoring team to at-risk individuals.
How Livi can help: Today, more than 30% of Livi patients in the UK are seen for a long-term condition (either related to management or exacerbation) and we serve patients aged 90 and above.
We help patients access care they need through both their practice and the Livi app. In addition, our practice platform, Mjog, supports remote monitoring with a range of patient engagement tools including clinical questionnaires and smart messaging.
Conclusion
There are huge ambitions for integrated care systems. And while fully realising digital maturity will take some time, application of these tools in some key areas (capacity, access, signposting and condition management) could help secure some quick wins and lay solid foundations for the future.
Livi has a range of solutions that helps partners do just that.
Livi Population increases the primary care capacity of health systems. We support ICBs, PCNs, GP federations and large practices, providing appointments around the clock and administrative support.
We build GP practice websites to NHS standards that drive consistency of experience at scale. Our platform helps patients navigate and access services in a given footprint, appropriate to their needs.
Mjog is the leading batch messaging platform for general practice. We help practices engage patients at scale and provide monitoring tools to support remote management.
To find out more and discuss your needs with our team, contact partnerships-uk@livi.co.uk
*In terms of median disposable income, based on ONS gross disposable household income
References
NHS Providers. Supporting ICS leaders to harness the potential of the digital agenda. Available online: nhsproviders.org/media/694757/digital-ics-insights-report-december-2022-final-1.pdf. Accessed April 2023
NHS Confederation. The digital transformation gambit: simpler, faster, safer services? Available online: nhsconfed.org/podcast/digital-transformation-gambit-simpler-faster-safer-services. Accessed April 2023
NHS Providers. Building a digital strategy. Available online: https://nhsproviders.org/building-a-digital-strategy/understand-the-system-context. Accessed April 2023
NHS Confederation. Reflections on the digital journey across Frimley ICS. Available online: https://www.nhsconfed.org/articles/reflections-digital-journey-across-frimley-ics. Accessed April 2023.
The Health Foundation. Level or Not?. Available online: https://www.health.org.uk/publications/reports/level-or-not#:~:text=There%20are%20fewer%20GPs%20per,for%20doctors%20in%20these%20areas. Accessed April 2023.
Gov.UK. The future of healthcare: our vision for digital, data and technology in health and care. Available online: https://www.gov.uk/government/publications/the-future-of-healthcare-our-vision-for-digital-data-and-technology-in-health-and-care/the-future-of-healthcare-our-vision-for-digital-data-and-technology-in-health-and-care. Accessed April 2023.
NHS England. Making the case for the personalised approach. Available online: https://www.england.nhs.uk/blog/making-the-case-for-the-personalised-approach/#:~:text=There%20are%20over%2026%20million,health%20and%20social%20care%20system. Accessed April 2023.
King’s Fund. Integrated care systems explained: making sense of systems, places and neighbourhoods. Available online: https://www.kingsfund.org.uk/publications/integrated-care-systems-explained#:~:text=Where%20next%3F-,What%20are%20integrated%20care%20systems%3F,reducing%20inequalities%20across%20geographical%20areas. Accessed April 2023.
NHSX. Using Technology to Reduce Chronic Obstructive Pulmonary Disorder (COPD) and Asthma Readmissions. Available online: https://www.nhsx.nhs.uk/key-toolsand-info/digital-playbooks/respiratory-digital-playbook/using-technology-to-reduce-chronic-obstructive-pulmonary-disorder-copd-and-asthma-readmissions/. Accessed April 2023.
NHS England. NHS Long Term Plan. Available online: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf. Accessed October 2022. Accessed April 2023.
