In this blog, Fraser Battye looks at NHS England/Improvement’s ‘Integrating Care’ paper. While not looking forward to another NHS re-organisation, he sees a lot that analysts will like. Fraser also notes the potential advantage that the Decision Support Unit model gives systems in the Midlands. What can analysts do to seize these opportunities?
In November, NHS England and Improvement (NHSE/I) issued ‘Integrating Care’. The paper confirms the direction of travel for health and, although not a focus, social care services. It also sets out options – including legislative options - for establishing Integrated Care Systems (ICS) across England.
The headlines are clear. Integrating Care continues the agenda of 2014’s Five Year Forward View and 2019’s Long Term Plan. Counting words is a cheap, but sometimes instructive, form of analysis. Here it reveals around 60 mentions of ‘collaboration’ and its derivatives, with ‘competition’ appearing just seven times. This is a further turn away from 2012’s ‘Lansley Act’*.
The document also contains around three times as many mentions of ‘local’ as ‘national’. So less competition and more collaboration; less national direction and more local discretion. This is surely the right direction given the well-rehearsed challenges facing services, and experiences of collaboration under the pandemic.
What might this mean for analysts? How does Integrating Care describe the role of analysis in improving outcomes?
My reading is broadly positive: this could be an opportunity for analysts to play a more significant role.
Analysis is essential given the task that Integrating Care sets out for local systems. ICS are tasked with working to get the best outcomes for the collective resources available to them. This requires analysis. Every ICS must: understand its population; know what current and likely future needs are; have an evidence-based view on what is likely to be effective in meeting them. This demands analysis of many different kinds, drawing on multiple disciplines**.
Analysts are recognised as a local resource. Pooling their talents and skills across partner organisations is one way that ICS can make more of the intelligence available to them. Local authority public health functions will be a rich source. And, in setting out changes to commissioning functions, Integrated Care also contains this little gem:
“Analytical skills within systems should be applied to better understanding how best to use resources to improving outcomes, rather than managing contract performance between organisations.”
A thousand times: yes. The focus on decision making is also very welcome. Integrating Care suggests that ICSs:
“Develop shared cross-system intelligence and analytical functions that use information to improve decision-making at every level”.
This is exactly the thinking behind the Decision Support Unit model being developed by many systems in the Midlands. The Strategy Unit shoulder is firmly against this wheel, acting as a specialist resource – a Decision Support Centre - to help these systems. And we were delighted when Simon Stevens recognised efforts in the Midlands.
None of this is a given; there are significant challenges ahead…
The first set of challenges are macro/political in nature. There is no guarantee that the suggestions in Integrated Care will carry through into legislation; any legislation will also take a view on NHSE/I’s role; and legislation will also be subject to political conditions and calculations. There is no straight path through any of this.
Assuming some approximate version of Integrating Care makes it through these challenges, there is then the consequent re-organisation. The paper recognises this, and NHS managers are well-practiced (indeed, over-practiced) at re-organising.
But this will certainly be distracting; and few seasoned observers would bet much on changes in organisational form leading to improved outcomes. There is a further question as to whether the NHS, which has a decades-long record of national command-and-control, will allow itself to provide meaningful local discretion. ‘Postcode lottery’ anyone?
More specifically, there will then be questions for systems as to how they make the most of their current analytical talents. Public Health England mapping suggests that there are more than 100 analysts in an ‘average’ system: very many of them badly deployed on tasks far below their skill level.
So how will ICSs identify their most promising analytical talent to form the suggested ‘intelligence and analytical functions’? Will individual organisations ‘give up’ their most talented analysts for the good of the whole system? How will these talents be networked, supported and professionally nurtured? How will they be tasked with important, strategic questions and insulated from the prosaic and everyday? (Etc).
Will analysts seize the day?
We can’t help with the politics (!) and we aren’t enthused by re-organisation. So Strategy Unit energies are firmly behind helping local systems and their analysts.
Some of this will be by example, as we seek to create a supportive environment for the analytical talents in our own team. Some of it will be networking and encouraging. Some of it will be further stoking the fire of the Analyst Revolution – certainly the analytical community needs to be bolder and occasionally more strident.
We are also working hard to support the formation of Decision Support Units across local systems in the Midlands. This model will give these systems – and the analysts within them – a real head start in seizing the opportunities presented by Integrating Care.
It would be a rash bet to say that the agenda described in Integrating Care will be fully realised in practice. It’s near certain that it won’t. But who would bet against an increasingly central role for analysts?
* J.F. Kennedy said “Victory has a thousand fathers, but defeat is an orphan”. That the 2012 Act is forever associated with a single name is a very pithy analysis.
** Here is not the place to explore this, but the NHS also needs to think broadly when using the term ‘analyst’. It is not a synonym for ‘people that work with quantitative data’, but a term that should encompass those who think analytically and critically, and who draw on many types of evidence to problem solve and support decision making.