The government has launched an initiative to bring NHS organisations and local government closer together, to increase collaboration and to ensure there is local care within hospitals and the local community.
Dubbed the Local Integrated Care Records Exemplars (LICRE) has been soft launched by NHS England and clearly understands that information is the key to greater care and collaboration in the community.
CIOs Richard Corbridge of Leeds Teaching Hospitals NHS Trust and Dylan Roberts,
Chief Digital and Information Officer Leeds City Council have jointly written to a number of organisations in their local Yorkshire communities. “This initiative will focus on how health and social care organisations can deliver integrated capabilities that share information to improve the integrated care journey of patients and inform population health management,” they both state in a letter seen by the Horizon CIO podcast.
“This feels like a government initiative to create a health and social care information fabric that will support the delivery of care,” says Corbridge who recently took up his position in Leeds. In their letter Corbridge and Roberts say:
“There will be five cohorts chosen nationally and each will represent a population of between three and five million. Over a twelve month period, these LICRE’s will build on solutions already in place across the geography in order to offer a more advanced level of integration of health and care information between NHS organisations and organisations delivering social care,” suggesting that this is not an initiative for new technology, but an opportunity to consolidate systems and break down silos of information.
Have lessons been heeded?
“This reflects the way the NHS is organised – so technology fitting in with the fact that the NHS is not so much a “National” health service in terms of the way the organisation is structured, resourced etc, but a set of local organisations operating under a common banner,” former healthcare CIO, government advisor and founder of Stance Global Jerry Fishenden says.
“Most people’s regular experiences with the NHS will be within their local area – their GP, local hospitals etc. Technology that maps onto the organisation and works to improve it, rather than trying to cut across it, tends to work better.
“Public sector organisations should be adopting new digital organisation models and consuming standard processes and functions across the sector to deliver more resource to the frontline. It’s an interesting potential way to support and improve local services, but without the massive local duplication of overheads,” Fishenden says.
“However … it also perhaps indicates that none of the lessons of the new organisational models now possible as a result of technology – based around outcomes (and not inputs and merely polishing the way services / transactions are currently designed) – has yet to make any significant impact in the public sector. So the current approach leads to large-scale duplication of inputs – management and administrative roles, functions, processes, systems, etc – in every part of the NHS because each fires up its own local instance, depleting the resources focused on outcomes,” he adds.
“A significant amount of effort has gone into building a cohort of the willing – a group of organisations who are excited by the prospect of working together to create a response. The geography of this cohort is the Yorkshire and Humber region and this has been chosen for a number of clear reasons. In healthcare terms it is a geography and population that shares several clinical networks and in the past has worked well together. From a social care point of view, it is a geography that has forward thinking leadership and localised success in the delivery of health and social care information as well as having well developed and agreed plans to do more,” their letter says.
The letter indicates that the presence of two leading electronic health records (EHR) implementations in the region and good adoption of primary care technology means Corbridge and Roberts are well placed to create a LICRE exemplar.
“LICRE would be important for Leeds and Yorkshire as no Global Digital Exemplar sites or Fast Followers,” he says of the Global Digital Exemplars (GDE) programme run by NHS England. “GDEs has created a Premier League of investment and promotion, LICRE ought to be the FA Cup opportunity,” Corbridge adds.
“This programme is technology agnostic and – done well – will address the governance and organisational barriers to information sharing,” says Owen Powell ICT Director for Central and North West London NHS Foundation Trust. “An Exemplar programme is just what’s needed to provide a methodology and roadmap to better joint working.”
Until last autumn Corbridge was CIO for the Health Service Executive (HSE) in Ireland, which is ahead of the UK in having closer collaboration between local government and the health service and Corbridge says Ireland is seeing the benefits.
“Integrated Care Records can bring a new level in efficiency and safety. Perhaps most importantly during these pressured times it allows the health system to have as much control over the information about patients leaving an acute hospital as it does about those coming into care in an acute hospital. Integrated care through a health and social care system is the most important advance we can make in avoiding the pressures that the healthcare systems of the globe have faced over the last four months, integrated care requires integrated information,” Corbridge says.
In addition to improving care and collaboration, LICRE aims to increase the information gathered and acted upon locally so that the NHS and local government have a greater understanding of the health pressures they face locally and how policy can help health management.
“Much has been written about the amazing work that has been achieved out of Newcastle, and certainly the Great North Care Record is a great achievement, what LICRE will do, we all hope, is expose the best practice and lessons learnt from as many as 50 different ways that integrated care has been built across the NHS,” Corbridge says. “In Yorkshire and the Humber we would dearly like the work that has been done achieving solutions like the Leeds Care Record and the superb work achieved in Bradford, Huddersfield and Calderdale deploying Cerner Millennium and in Sheffield the clinical benefits that have been achieved in the implementation of DXC Lorenzo solution ought to also be celebrated, learnt from and be part of our wider understanding of what a system of systems can be.”
“To get anything done in this area you need a manageable geographic region, with the really crucial element of senior alignment across the various fiefdoms,” says Andy Beale, former CTO at the Government Digital Service and now a founding member of Stance Global, an advisory service. Beale adds that the overlap between local government and healthcare in cities like Leeds are ripe for improved social care through technological means.”