This section contains
Aims
Be radical and ambitious:
- Scale up successful innovative practice
- Share learning more widely
- Embrace integrated technologies.
Context
The collaborative approach needed by integrated care systems (ICSs) requires new ways of sharing data and learning.
At the level of people's individual health data, shared GP records can benefit both systems and the people who use services. See the initiatives at Birmingham and Solihull ICS and Cambridgeshire and Peterborough CCG for more on how this works.
Margaret's story shows how frustrating it can be for people and their families when records are not shared between services. Moreover, if services do not have timely access to a person's health record, there is an increased risk of misdiagnosis or inappropriate care. The COVID-19 pandemic made this issue even more acute, as some people cannot always advocate for themselves. Visiting restrictions meant carers and loved ones were not always present to speak on a person's behalf.
At the level of individual services, we should employ innovative measures of cost, performance and productivity. Impact should be measured beyond individual service budgets. System leaders should also consider their influence on the wider health and social care economy.
The scale and delivery of services should be determined by the root causes of people's health needs. For example, efficient, well-resourced community fall teams can prevent people, often living with frailty, from significant injury. Not only does this benefit the person, it reduces demand for hospital beds and surgery.
At a system-wide level, information needs to be relevant, easily accessible and actionable. Some data, such as capacity or demand levels could be made publicly available. Sharing insights on system pressures can discourage a 'blame game' culture. It allows system partners to:
- make informed decisions
- share risk across the system
- improve access to care.
It also offers greater transparency for users of services.
There needs to be clear understanding throughout the ICS of what innovations work well. Impact should be measured across the ICS. The innovations that perform well should be scaled up.
Sharing this learning is important too. It gives all systems and services the opportunity to learn from each other. They can then adopt, or adapt those innovations to suit the needs of the people who use their services.
Key suggestions
- Share IT systems across the ICS to give system partners live, relevant and accurate data. Provide the right amount of support to implement it well.
- Make sure electronic patient records are available to all system partners.
- Use technology that aids effective decision-making, while minimising the need to switch between IT systems. For example, digital notes that include blood tests and radiology on the same system.
- Use virtual review systems to reduce avoidable hospital admissions and delayed discharge.
- Explore innovative partnerships with networks from academia, research and industry.
- Plan safe and efficient flow of people in acute trusts using future prediction models such as:
- predicted attendances
- projected occupancy for beds in care homes, intermediate care and discharge to assess.
- Consider digital solutions that help support people with urgent health and care needs.
Examples of good practice and innovation
Virtual clinics
Many virtual clinics were established during the pandemic. They should be maintained and iteratively improved. They include:
- virtual follow-up clinics
- virtual wards, SDECs
- fracture clinics.
They extend to other innovations too. For more information, see Future Healthcare Journal: Possible futures of acute medical care in the NHS and the Hospital at Home Society.
Digital solutions for dentistry
CQC Provider collaboration review on urgent and emergency care
In this review, CQC highlighted how digital solutions supported some people with urgent dental needs. They included:
- Remote triage where people send videos and photographs to their dentist to help them diagnose and prescribe.
- ‘Attend anywhere’ a secure web-based platform for patients with pre-arranged video consultation appointments. This was introduced nationally to improve access for people and reduce travel needs.
CQC's UEC work also saw initiatives that manage demand and capacity. For example, in Gloucestershire, an NHS trust directed people to the appropriate services using both:
- telephone clinical triage
- a dental line that offered a clinical assessment service (CAS).
See the full provider collaboration review.
GoodSAM App
London Ambulance Service and East of England Ambulance Service
Some services have partnered with GoodSAM app. This app connects the ambulance service to a network of trained volunteers by issuing alerts to volunteers on their smartphones. If they are available, they can respond to life-threatening emergency incidents. Subject to robust governance to ensure all volunteers are fully trained, more services could invest in this technology and use it more widely across the country.
Find out more from the London Ambulance Service
Shared system dashboard for ICS partners to support escalation
A system-wide shared dashboard can support escalation measures across an ICS. No decisions should be made on a single metric in isolation. They should offer relevant, actionable metrics that reflect access to all services, not just emergency departments and ambulance handover times.
The dashboard can include access data from:
- GP services
- Dental services
- Walk-in centres
- Minor injury units (MIUs)
- Urgent treatment centres (UTCs)
- Same day emergency care services (SDEC)
This could extend to procedure waiting times, transport services and links, and community and social care bed capacity.
System-wide dashboards that measure performance, productivity and demand beyond urgent and emergency care
The system-wide demand and capacity dashboard may also show the need for services outside urgent and emergency care. For example:
- dental services
- sexual health
- early pregnancy services (EPAU).
System-wide dashboards can also measure productivity and performance. This provides a way of measuring the outputs of services. It can also test the effectiveness of services and pathways, especially when testing new pilots.
Use of artificial intelligence and drones in ambulance services
Some ambulance services are exploring the use of:
- artificial intelligence (AI) in call centres
- drones to deliver automated external defibrillators (AEDs) to remote places.