Abstract
In this article, Knight and Burdett look at the complex challenges involved in integrating care systems as part of the NHS Long-Term Plan of 2019, and the importance of digitalising services and records for implementing this.
‘Integration’ is at the centre of the NHS Long-Term Plan of 2019, 1 with a continuing emphasis on place-based systems and integrated care. This has been a fundamental aspect of recent NHS policy, with a strategy to ‘use the next several years to make the biggest national move to integrated care of any major western country’. 2 Building on these fundamentals, the 2019 Plan promises the development of totally integrated community-based healthcare. It spells out a strategy for all areas of England to be part of integrated care systems (ICS), which by April 2021 will normally be one clinical commissioning group (CCG) per ICS area. New integrated systems of care are anticipated to enhance population health by improving service provision outside hospitals, with prevention and personalised care 1 being central components of the Plan.
Integrated care can bring an extensive scope of benefits.3–6 The intrinsic basis is that ‘integrated care is adaptable and can respond to the local arena whether that is due to our patient population health and care needs, resource issues or evolving societal changes’. 3
Personalised care is, by its own definition, holistic. It needs to be available in the format of joined-up services for patients, which need to be fortified by a multidisciplinary partnership approach, with networks stretching across and through health, social care and the voluntary sector. The planned integration of primary and secondary care, which includes social care and the voluntary agencies, is underpinned by £4.5 billion of new investment. This is anticipated to create expanded community multidisciplinary teams within the integrated care systems. 1 A strategic emphasis on integration will require ‘streamlined commissioning arrangements’ 1 where neighbouring general practices will join together to form primary care networks (PCNs), which will usually include 30–50,000 people.
However, there are several challenges to integrated care. In particular, these relate to digital technologies and digital literacy, both of health and social care professionals and also the population, which may impede these changes.3,7 The digitalisation of health provision underpins many of the changes envisaged for the NHS and is depicted as central to the enhancement of patient care and NHS reform. 1
System change and investment is required to enable such an ambitious use of technology. The National Programme for IT (NPfIT), a £10 billion-plus investment in digitising the records of all NHS patients, ‘only achieved a fraction of the original vision’. 8 The present investment, infrastructure and digital volume within the NHS, and the expertise necessary to enable successful future projects to materialise, may well be crucial obstacles to effective digitalisation of services and provision. 9
The workforce itself requires training and upskilling to cope and be confident with new technologies. In addition, they need to be flexible and adaptable given the fast pace of change, as new systems are constantly being developed and implemented. The onus for this upskilling is not only on the individual, but is also incumbent on employing organisations and educational establishments alike to facilitate and support this. Furthermore, some segments of society, including older people, may feel disregarded or have communication difficulties that make digital access less suitable for them. 9 Fenge et al. 10 identified that older users of technology are not one homogeneous group as there are vast differences in ages, skills and morbidities/co-morbidities. This means that ‘usability, learnability and efficiency and satisfaction for the user’ 11 need to be considered when empowering older people to develop their digital literacy skills. Issues of equity and access to health and social care between urban and rural areas, as well as the differences within the broadband infrastructure, need to be addressed.11,12
Ultimately, these complex challenges need to be addressed by digital empowerment if the roll-out of digital health proposed within the NHS Plan is to be successful.
