As relationships between Integrated Care Boards (ICBs) and Provider Collaboratives mature within developing Integrated Care Systems (ICSs), a significant area that presents both opportunity and challenge will be the approach to digital convergence and data sharing across ICSs.
The recent Hewitt Report suggested that Provider Collaboratives have the potential to be the ‘core NHS delivery arm for achieving key system objectives’. As the digital agenda is a key focus for ICSs, we expect Provider Collaboratives to play a major role in achieving convergence and the adoption of shared digital solutions.
Provider Collaboratives and ICBs seeking to effectively advance digital development and cooperation within their ICS will have to navigate familiar challenges regarding resource allocation, delegation of decision-making, and division of responsibilities between the Provider Collaboratives and their ICB that we have seen emerge during the early stages of the new ecosystem. Inevitably, these organisational challenges will have a particular impact on digital objectives as it can be difficult to work towards convergence of digital solutions without first establishing consistent decision-making at appropriate seniority levels across the ICS.
Historically, there has been a mixed approach to data sharing between NHS organisations, not to mention with non-NHS partners in the ICS (including local authorities) and while some NHS organisations may have already fostered an environment that encourages healthy cooperation, others may still be developing this and there could still be limited communication across organisational boundaries. Depending on the extent to which shared digital platforms and solutions are already in place, there is still a high degree of local variation and Provider Collaboratives will each have their own experience to navigate.
Given that many digital solutions are procured under lengthy contracts (for example many EPR systems are contracted for terms lasting 10-15 years), the enduring nature of these solutions means it is crucial for Provider Collaboratives to make sure any shared digital solution is fit for purpose and supported by a robust contract. It also demonstrates the importance of planning for digital convergence well in advance so that the expiry of existing supplier contracts across partner organisations can be managed in the lead up to the implementation of new shared solutions.
Some key themes that we recommend Provider Collaboratives and ICBs consider when planning a shared digital landscape across their ICS include:
- Alignment of supplier solutions across sites. Despite a continued requirement for digital interoperability across many public sector frameworks, suppliers have an innate commercial reason to make it complicated for their customers to leave their ecosystem and so (particularly in areas where convergence is still relatively undeveloped) true interoperability is still proving difficult to achieve. Additional challenges such as overlapping or incompatible datasets between different digital services and suppliers or trying to avoid wrestling with a series of discrete app stores can create additional barriers.
- Shared Databases. Use of a shared database is often an integral part of digital convergence and the sharing of digital solutions across ICSs, but it’s important to account for the data protection and privacy implications that come with this. Information Governance teams should be involved at an early stage to ensure that the data processing relationship(s) is clearly understood and supported by accurate documents, such as a collaboration agreement or data sharing agreement.
- Maintenance windows. Most digital solutions will include arrangements for planned maintenance and arranging convenient times for this work to take place can be difficult, particularly in acute healthcare settings. When a solution is shared between more than one organisation, it is even more important to manage the logistics and coordinate suitable maintenance windows that work for all organisations.
- Day-to-day management. Consideration should be given to the best way to govern the day-to-day operation and management of digital solutions/suppliers. It may be that regular meetings between members will suffice, but for substantial services it may be better to create a specific project team that is granted a level of autonomy. It may also be appropriate for one NHS organisation within the Provider Collaborative (for example) to host the solution and provide a services wrapper to the wider Provider Collaborative. In each case, these arrangements work best when supported by clear operational and contractual documents that define the roles, responsibilities, risk exposure and commitments of each organisation involved.
- Aligning policies and Standard Operating Procedures. In much the same way, good digital convergence relies on alignment of ways of working between organisations as well as suppliers. For example, Provider Collaboratives may want to consider harmonising policies and standard operating procedures across its Trusts in order to help streamline and improve the management of shared digital solutions.
- Legal input. Unfortunately, we often see situations where clients seek legal input too late in the procurement process, which severely limits our ability to provide valuable advice. This may occur in an attempt to manage costs, but the consequence is that clients may have already chosen an ill-fitting framework or started a procurement process without considering a key requirement. Ultimately, decisions like these can result in significantly increased costs when trying to resolve the issues prior to contract signature. We recommend that legal advisers are brought on board early in the convergence process so that organisations can benefit from practical experience and conduct more efficient procurements of shared digital solutions as a result.
This piece is one of a series of articles on Provider Collaboratives, previously including the Hewitt Review’s implications for Provider Collaboratives, why an understanding of estate is fundamental to integration plans and employee portability in practice.
We are delighted to confirm that we will be running a session at this year’s NHS ConfedExpo in Manchester on 15 June around developing collaboratives within the new NHS. The session will discuss successes and setbacks of collaboratives to date, as well as looking forward to 2023/24 and beyond to understand upcoming challenges and opportunities for provider collaboratives. Find out more at ConfedExpo’s website, and sign up now to make sure you don’t miss out the insights from our stellar panel of industry leaders.
For further information, please contact:
Esther Venning, Partner, Hill Dickinson
esther.venning@hilldickinson.com
