In a recent article I described the NHS estate as the “glue that holds everything together.” For a bit of context, the NHS Estate is the third biggest spend after people and medicine. It is not possible to consider any change within the NHS without understanding how the estate might be impacted or how it might enable that change. The introduction of the Integrated Care Systems (ICS) in summer of 2022 meant that these bodies must be able to work at building, site, Trust and regional level. This required the monumental task of consolidating NHS Trusts whilst maintaining business as usual and planning for the future. The decision-making is truly complex and should be admired.
In August 2023, the NHS Confederation issued a report of the first year of the ICS anniversary entitled “The state of integrated care systems 2022/23: Riding the storm.” It included some positive messages around a “strong start” and “working collaboratively” and identified three main barriers, “staff shortages”, “funding for social care” and “NHS finances”. It also identified that the ICSs supported “the government’s commitment to reviewing the entire NHS capital regime in response to the Hewitt review”. It also asked that the review included both the “amount of capital funding” and “the complex allocation process, which is resulting in delays in accessing funding that could be used to enhance productivity.”
In December 2023 the delayed and eagerly awaited update of the 2024/25 Planning Guidance confirmed that the priorities and objectives set out in the 2023/24 Planning Guidance would “not fundamentally change.” Or put another way, you have to do more with less (in real terms). The progress that had been made by August 2023 is now under increased pressure and at risk of going backwards.
The Future for ICS
To avoid undoing the positive work to date the ICS need to find ways of working smarter and securing funds. In my experience, the effective use of the organisation’s data becomes a rallying point for all parties. Teams need a shared understanding of where they are and where they are going, and data captures that real position. Data can be the common ground that everyone can share and get behind – rich and mature data provides the evidence and common language everyone can trust and support. When done well, this will make a significant difference to the quality of business case submissions and their likelihood of success. And there is nothing like success to integrate a team.
The complexity of the combined NHS organisations cannot be understated. The data capture, cleansing and analysis can demystify this complexity and then be used for modelling multiple options. This is a critical part of successful business cases.
Summary
The key thing for the ICS is that the data enables complex modelling of issues such as changes in healthcare delivery models, space reconfiguration, creation of new healthcare facilities and the integration of digital advancements – whether it be at local or regional levels. I’ve found that the required skill is the ability to work on cross functional data sets and work out the relationships between them. Reliable data improves communication and collaboration among stakeholders.
