Integrated Care Systems – the TLA (three-letter abbreviation) with staying power
I have a theory that years can be recalled by their three-letter abbreviations (TLAs).
One of the less serious consequences of Covid-19 has been the rich legacy of TLAs that now permeate our everyday lives. We no longer meet F2F. We WFH, where we take our LFTs and PCRs. For many of us working in the NHS, ICSs have become another ubiquitous TLA – the subject of a lot of discussion, and varying levels of action depending on your area of the country.
Whilst it’s unfair to say that ICSs are a result of Covid – they pre-date it by several years – it’s certainly true to say that the importance of place-based models of care, as embodied by the Integrated Care System, has come into sharp focus over the past two years. Indeed, thanks in part to Covid, around ninety per cent of people’s interactions with the NHS now occur in their own homes, a GP practice, pharmacy, dentist or local clinic.
That’s one of the reasons why the new Health and Care Bill, and the introduction of statutory ICSs from July this year is so important. Crucially, ICSs are not just the preserve of the NHS. They are a partnership of equals, with local councils, voluntary bodies, service users, carers and families.
This seismic shift in thinking that underpins the introduction of statutory ICSs means that working between and across organisations has never been so important. ICS implementation guidance – published by NHS England and NHS Improvement in August 2021 – outlines the expectation that NHS providers form ‘provider collaboratives’ to plan, deliver and transform services, working effectively at scale to tackle unwarranted variation.
The directive points specifically to the opportunity for ICS members to join up corporate services and leverage joint purchasing power to achieve efficiencies and economies of scale.
This is something my organisation – NHS Shared Business Services – knows something about. Established by the Department of Health and Social Care to provide exactly the type of efficiency and economies of scale referred to above, we are now working with pathfinder ICSs to design and deliver shared corporate services that enable them to collaborate and truly fulfil their potential. Things like a single, unified Source to Settle system, which enables system-wide strategic procurement and instils best-practice finance processes as the norm.
We have also been engaged to provide insights into the current functioning of nascent ICSs – benchmarking the maturity of systems and processes across each member organisation to provide a baseline on which to make improvement decisions. One thing that’s clear to me is that we can’t build the foundations of a health and care transformation on foundations of paper. Clinicians have become experts in harnessing technology – look at the progress that’s been made in minimally-invasive surgery for example. Accountants, finance officers, HR and procurement professionals need to follow suit. That’s why we’re working alongside ICSs to ensure the NHS ‘digital first’ agenda for patient care is mirrored across corporate services. This includes accelerating the use of electronic processes as standard, such as eInvoicing, eProcurement and ePay, the latter for things like employee expenses, timesheets and HR forms.
I know a lot of organisations claim to have these things in place already. But something I see repeatedly across the health and care landscape is digital substitution – where a fundamentally paper-based process is given a veneer of digitisation. One of the most egregious offences is also one of the most ubiquitous – Word documents being uploaded to an intranet, with employees expected to download, complete and return by email. That is not ‘digital first’. And it’s not a way to make the most of the precious resources of the health and care sector, or to enable efficient collaborative working.
We are investing tens of millions of pounds in our people, processes and platforms, including a new market-leading finance system, which will transform user experience and help underpin the future success of all 42 ICSs
The continuous improvement of our services in recent years has also included substantial investments in areas likes our award-winning automation programme, which saves 500,000 processing hours every year via technologies such as Robotic Process Automation (RPA). This has led to improved service accuracy, and enhanced service quality as humans are freed up to do the things than humans do best – build relationships to solve problems.
Over 100,000 users now also use our payroll app, MySBSPay, which has saved NHS employees around 4,000 hours a year by providing round-the-clock and easy-to-understand access to NHS payslips. This reduces the time NHS staff need to spend on common payroll queries to our service desk – resource that is far better spent on the frontline.
With more and better technology platforms becoming available all the time, we need a shift away from talk and a focus on rapid commitment and action. Building strong and enduring partnerships can take time, but the pandemic response has shown how quickly it’s possible to change established ways of working. If we are serious about 2022 being the year of the ICS – rather than yet another TLA – we all need to make place-based health and care BAU.