By Stephanie Diller, Public sector health Consulting and Aiden Hannah, Deloitte Centre for Health Solutions

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The 1st of July 2022 and the establishment of Integrated Care Boards (ICBs) as statutory bodies to lead the 42 geographically based ICSs presents an unparalleled opportunity for a fundamental shift in the way health and care is planned and delivered.1 This week’s blog highlights the crucial role, and ongoing challenges, of effective data sharing to optimise the benefits of integrated care. It draws on semi-structured interviews with a range of ICS leaders conducted by Deloitte during 2021 and our recent experience work with ICSs and relevant NHS organisations.

The use of data has been a critical enabler of ICS formation

While ICS maturity levels vary across geographies, ICS leaders identified that a critical enabler of progress has been the use of data and analytics to drive outcomes-based working, support leadership decisions, improve resource allocation and begin to tackle population health management (PHM). The power of digital and data has enabled staff to work outside of organisational silos and deliver more joined-up, user-centred care. This has helped ratify the case for integration, highlighting the importance of bringing together health data with local authority, voluntary sector and wider determinants of health data to understand the patient’s whole experience of health and care, anticipate their future needs and improve pre-emptive care.

Despite the pandemic causing many NHS organisations to pause their ICS transformation and implementation plans to deploy much needed resources and capacity elsewhere, while also changing ways of working at an unprecedented scale and pace, our interviewees reported a number of benefits from the overall impact of COVID-19 upon ICS development (see Figure 1).2 Crucially, many of these benefits such as increased openness and digital adoption lend themselves well to supporting improved data sharing in future.

Figure 1. Positive impacts of the COVID-19 pandemic upon ICS development.

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Data sharing remains a challenge

While there have been notable improvements in the use of data throughout the pandemic, many challenges still exist that prevent more widespread, timely and effective data sharing across ICSs. For example, at the start of the COVID-19 pandemic, emergency measures were brought in that required NHS Digital to share confidential patient information to select organisations under the Control of Patient Information Regulations 2002 (COPI), to support with efforts to control the virus. The ability to share this data under COPI came to an end in June 2022 and while there is an expectation that new arrangements will be introduced, there are concerns that this will undermine the research, development and adoption of innovation seen during the pandemic.3

The variation in the maturity of Information Governance (IG) across legacy NHS organisations and local authorities is a further frustration in effective data sharing. There is an expectation that ICBs should be able to address this by bringing local CCGs together into a single legal entity. However, challenges remain in ensuring that the data platforms that are used are designed to enable interoperability and secure data sharing to facilitate an effective  PHM approach and support ICS wide decision making and that provider organisations don’t use IG as a reason for not  providing data.

Public appetite for data sharing relies on trust. Trust of the government, the healthcare system, and in the use of ethical standards, for the use of data. It also relies on the benefits outweighing the risks. Public perception and trust in organisations to use, store, share and protect data is essential. A lack of consistency between data sharing consent forms and some organisations taking a more risk averse stand can undermine this trust.  Moreover, wide variations in the maturity of the IT infrastructure and a lag between data collection, data sharing, and related actions, were also seen as constraining the effectiveness of data-enabled decision making.

Creating a digitally mature infrastructure to drive integrated care

To deliver integrated care and achieve better outcomes for the population, our interviewees identified several priority focus areas (see Figure 2). Again, the importance of data and analytics was referenced the most frequently, including linking datasets and improving the ease of data sharing.  Given ICSs need the right data and infrastructure to understand the health of their populations and service demand, all member organisations need to collect and share appropriately structured and timely data that is robust, reliable and actionable. To produce the right insights, requires  the input and engagement of clinicians, public health and social care experts to derive insights for effective PHM. 

Figure 2. Summary of the priority areas ICS leaders believe should be focused on to deliver integrated care.

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Source: Deloitte analysis of ICS leader interviews.

Better data and advanced digital maturity are required to enable an evidence-based approach, as well as transparent and consistent performance metrics against which progress can be measured. The Government’s  Integration White Paper for health and social care, in February 2022, stated that only 21 per cent of NHS Trusts are classed as digitally mature, with ten per cent still relying heavily on paper.4 Furthermore, the whitepaper states that by 2024, a minimum level of digital maturity will be required for health and adult social care providers within an ICS, with each provider and the patient being able to access a single secure shared care record. The scale of this challenge is heightened when considering the integration of data from wider organisations and the voluntary sector and their similar spectrum of digital maturity. This integration cannot be achieved quickly and developing a roadmap which prioritises this work across ICS partners is key.   

The adoption of universal data standards and frameworks will also help. The recently published government strategy ‘Data saves lives: reshaping health and social care with data’ consolidates existing standards and sets out plans to ‘address the current cultural, behavioural and structural barriers in the system, with the ultimate goal of having a health and care system that is underpinned by high-quality and readily available data’.5 The data strategy prioritises increasing transparency and understanding on how data is used, supporting staff to making data sharing commonplace across health and social care, and creating the right technical, legal and regulatory infrastructure.

ICSs have a crucial role to play in engaging partner organisations and promoting the importance of data sharing in PHM by providing support and assurance that information sharing can be undertaken legally, ethically and securely. It is also important that ICSs identify clinical and care champions to promote the value of using data to inform care delivery, design of new pathways and make the right decisions for patients; and for clinicians and governance professionals to engage early and proactively to speed up information sharing to improve patient care. ICSs also need to ensure that their workforce has the technical knowledge and skills to utilise the data and insights effectively. The creation of ICSs provides the opportunity (leadership, coordination, cooperation, and resources) to enable action at the system level that improves the digital literacy of staff and patients.6


Conclusions

Data sharing across services is central to providing joined-up care. However, differences in interpreting IG between commissioners (ICBS) who have the statutory duties and providers who often have the data need resolving urgently. The lack of a joined-up IT infrastructure and getting partner organisation buy-in on the importance of data sharing, also needs to be addressed as a priority. Likewise, ICS leaders need to prioritise enhanced and standardised sharing and use of data. Furthermore, a clearer understanding of when data can be shared is required. To enable a more data-led future for integrated care, ICS, clinical and care leaders should share learnings from their experiences to date and develop case examples that demonstrate the value of data sharing in providing effective integrated care. By tackling current barriers to data sharing across the ecosystem, ICSs can achieve outcomes-based, integrated ways of working that benefit the individuals and populations they serve.

Acknowledgements

Many thanks to Dr Karen Kirkham and Catherine Skilton for their roles in conducting the interviews, and Emma Southgate, Amanda Eagle and James Banham for their contribution to the thought leadership.  

 

LSHC blog 3 Dec author

Aiden Hannah, Research Analyst

Aiden has a background in physics and biomedical engineering, and a strong technical knowledge of diagnostics and digital healthcare. Most recently working as an academic researcher, he undertook a range of multidisciplinary projects involving close collaborations between MedTech companies and clinicians; supporting the development of novel biosensors and low-cost diagnostics, including clinical trial design and conduct. Aiden has focused on the health technology investment pipeline and the medical device regulatory processes as part of his doctorate industry placements.

Email | LinkedIn

Deloitte-uk-stephanie

Stephanie Diller, Senior Manager

Stephanie leads on Integrated Care System Development and Population Health Management approaches. She brings national and international health consulting experience advising system leaders on the strategy through to implementation of new operating models to achieve integrated care. Her experience includes advising on developing new operating models, service redesign, technical development support to teams, workforce transformation, digital health strategy, design of new care models, and population health management strategies.

Email | LinkedIn

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1 https://www.digitalhealth.net/2022/06/what-does-the-end-of-copi-mean-for-digital-health-innovation/

2 https://www.gov.uk/government/publications/health-and-social-care-integration-joining-up-care-for-people-places-and-populations

3 https://www.gov.uk/government/publications/data-saves-lives-reshaping-health-and-social-care-with-data

4 https://blogs.deloitte.co.uk/health/2021/04/integrated-care-systems-establishing-a-patient-centric-health-and-care-system.html

5 https://www.gov.uk/government/publications/data-saves-lives-reshaping-health-and-social-care-with-data

6 https://blogs.deloitte.co.uk/health/2021/04/integrated-care-systems-establishing-a-patient-centric-health-and-care-system.html

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