By Catherine Skilton, UK Public Sector Lead Partner for Integrated Care Systems and ConvergeHEALTH, Deloitte’s healthcare software products business
The shift towards a digital-first healthcare system has accelerated during the COVID-19 pandemic, demonstrating that, given the opportunity for better access, people will engage in new ways with their health and wellbeing services. However, while many individuals have developed a greater awareness of their health and taken meaningful steps to improve it, the pandemic has exposed, and potentially increased inequalities in health outcomes due, in part, to inequalities in access to the technologies, connectivity, and digital and/or health literacy needed to improve outcomes equitably. Moreover, for some individuals improving health and wellbeing may not be their top priority, so new ways of engaging people, grounded in behavioural science, are required to optimise engagement with different segments of the population.
The wholesale move to Integrated Care Systems (ICS) and ICSs becoming statutory bodies provides an opportunity to give greater priority to patient engagement and to integrate services around a 360 degree view of patient’s needs, focusing on how people experience their lives and health conditions, rather than on specific treatment/disease areas or pathways. This blog discusses what ICSs can do to realise the long-held vision of a person-centric health and care system.
Patient engagement and designing care around the individual
For the past decade, our research reports have highlighted the benefits of using digital tools to provide timely, relevant and appropriate health data that would support people to be active participants in their own care as well providing Health & Care Professionals (HCPs) with access to data to support their patients more effectively.1,2,3
Figure 1 illustrates the conditions we consider are needed for effective patient engagement and includes a quote made in 2012 by Leonard Kish, a science-driven health entrepreneur aiming to drive more individual centricity into healthcare and technology systems.4 Crucially this identifies the need for the health and care system to be receptive to patient engagement, which has often proved challenging given the traditional care silos that have historically existed.
Figure 1. The conditions for effective patient engagement
Source: Deloitte Vital Signs Report
Building strong and integrated care systems across England with citizens at the heart of care design
In the UK today, health policies are shifting to prioritise development of personalised care approaches, putting patient engagement strategies and person centric-design at the centre of plans to improve population outcomes. Recent ICS guidance, ‘Integrating care: next steps to building strong and effective integrated care systems across England’, published in November 2020, builds on the vision set out in the NHS Long Term Plan, and recommends putting the citizen at the heart of their care through:
- the creation of a roadmap for citizen-centred digital channels and services
- the roll-out of remote monitoring
- that ICSs should build on the experience of data sharing during COVID-19, with further actions to follow.5
In addition, the Department of Health and Social Care's Health and Care White Paper in February 2021 highlights the potential role for ICS’s to provide ‘greater choice and control to patients by transforming services around the specific needs of their populations’.6 Consequently, ICSs are uniquely placed to use digital technologies to connect with their communities, implement effective engagement strategies for the benefit of individual patients and the wider population, and improve digital access so that individuals can manage their own health better.
Barriers to person-centred care
Some of the main obstacles to person-centred care that we have observed include:
- activity based funding
- lack of interoperability – both within and between health and care providers
- inconsistently defined data points and the lack of adoption of common standards across the system, hindering ability to join up care
- a reluctance to put health data into the hands of patients and patients lacking effective ways of linking their own data (such as from apps and wearables) to their care records
- a focus on treatment not prevention and siloed approaches between health conditions
- wide variations in digital and health literacy slowing the pace of adoption of digital solutions.
Ultimately, this has led to an inconsistent and inefficient approach to patient engagement, as shown through the proliferation of fragmented solutions such as patient and clinician facing apps and patient portals focused on individual therapeutic areas– which makes care difficult to manage from a patient perspective (e.g. if managing multiple conditions or being treated by more than one care provider). This fragmented approach has also made it more challenging for HCPs to see a 360 degree view of the person and their care needs to inform their decision-making on how best to manage that individual’s care.
Arguably the greatest challenge has been the focus on existing care models and ‘digitising’ traditional care pathways which, as we highlight in our ‘Closing the digital gap’ report, has often been inefficient and failed to deliver efficiencies or improve access or patient outcomes.7 What is needed is a focus on ‘digitalisation’ and integrating digital technologies to help re-imagine the way care is provided to and experienced by the patient. This should also involve creating a 360 degree view of the patient’s needs, identifying solutions and services that can address them holistically, while also enabling people to manage their own care. Our recent conversations with ICS leaders, encouragingly, highlight an acknowledgement of, and energy directed at, designing digitally enabled services around their populations’ health and care needs rather than within individual therapeutic areas.
A framework for digital patient for ICSs to consider
Delivering the vision of a digitally-enabled, patient-centric, integrated care system requires leadership and coordination to ensure a focus on designing services around people. It also requires the establishment of an underpinning health IT infrastructure to enable shared access to real-time health data and efficient deployment of validated digital health technologies. This infrastructure can be enabled through a robust governance framework that supports a culture of digital transformation (including clarity over data ownership, patient consent and education, application of approved data security and usability standards, and development of leaders with digital mind-sets). Improving the digital literacy of staff and patients’ also needs to be a priority, requiring action at the system level. The creation of ICSs provides the opportunity (leadership, co-ordination, co-operation and resources) to achieve this.
To support ICSs in planning for this important transformation Deloitte have developed a set of principles for digital patient engagement (figure 2). While no one element will be sufficient to deliver the desired transformation of population health and wellbeing, if considered in tandem and scaled incrementally over time, we believe that our vision for the ‘Future of Health’, where the balance shifts fundamentally from giving and receiving of care to sustaining wellbeing, becomes a reality.
Figure 2. Principles for Digital Patient Engagement within an ICS
Source: Deloitte LLP
Moving towards digital patient engagement and integrated care
The recent acceleration in use of digital technologies across the health ecosystem in response to the COVID-19 pandemic, and the associated increase in the public’s appetite for the delivery of health and care in non-traditional settings, creates an ideal opportunity for ICSs to establish a transparent, formal responsibility for their population’s health and wellbeing. There is also a clear opportunity for ICS leaders to re-imagine patient engagement, building on the evidence-based good practice that already exists to unlock the art of the possible for the ICS. While each ICS will likely take their own approach to addressing the challenges set out in this blog, we see this digital-first vision for an integrated care system being enabled by investing in modular and open foundational technologies, and using an agile approach to digitalisation to optimise effective patient and clinician engagement over time. This will necessitate the ICS equipping both patients and clinicians with the education and capabilities to successfully deliver digitally enabled personalised care.
1 Deloitte UK Centre for Health Solutions, ‘Healthcare and Life Sciences Predictions for 2020’, 2014.
2 Deloitte UK Centre for Health Solutions, ‘Connected health: How digital technology is transforming health and social care’, April 2015.
3 Deloitte UK Centre for Health Solutions, ‘Vital Signs: How to deliver better healthcare across Europe’, June 2016
5 NHS England, ‘Integrating care: next steps to building strong and effective integrated care systems across England’, November 2020.
7 Shaping the future of UK healthcare (deloitte.com), June 2019