The new integrated care systems (ICSs) have been making mixed progress with their digital and data strategies, according to the National Audit Office (NAO).
It has made the point as a detail within its report on the introduction of ICSs, which says they have been broadly welcomed but are under pressure from the service and financial pressures on the NHS.
ICSs have been set up around England, working under integrated care boards, to join up health and social care services.
In a reference to the issue, NAO says that ICSs were expected to have plans for digital and strategies in place by April of this year, but there has been a variation in their progress.
It cites Nottingham and Nottinghamshire ICS as an example of using data innovations in population health management, but says others have had to acknowledge they have capability gaps in digital.
It also gives NHS England credit for creating a good practice framework to help health and care leaders to digitise services and providing good support for cyber security.
Support and restraints
On a broader front, the report says ICSs are widely supported by stakeholders, but are already hampered by staff shortages in health and social care, increasing demands on their services and the reduction in local government spending power since 2010.
In addition, NHS England and the Department for Health and Social Care (DHSC) recognise that health outcomes are largely driven by wider factors beyond clinical healthcare, such as healthy behaviours, social and economic reasons, and the physical environment. But there has been little progress on establishing a structured approach for addressing these wider factors, which are affected by the policies of almost all central government departments.
NAO says there is an inherent tension between the local needs based care strategies that ICSs are expected to prepare and a standardised health service delivering national NHS targets. ICSs must manage these tensions, achieving efficiency targets and the national priorities NHS England has identified if they are to create capacity and resources to respond to local priorities.
In response, it recommends that DHSC works with departments across government to establish arrangements to address issues beyond clinical healthcare that contribute towards poor health, such as education, employment, benefits, and transport.
It should also publish the assessment of long term factors affecting the health and regulated social care workforce that it commissioned from Health Education England, and the NHS plan to address staffing shortages.
Realistic objectives needed
Gareth Davies, head of NAO, said: “The new model of integrated health and social care services is being implemented with broad support, but at a time of extreme pressure on both services. To maximise the chances of success for these new arrangements, DHSC and NHS England need to put realistic medium term objectives in place.
“They must also tackle pressures on ICSs that require action at a national level, including workforce shortages in health and social care.”
