NHS England set to build an ‘intelligence function’ for integrated care

NHS England has released its plans and published guidance for creating an intelligence function for integrated care system (ICSs) to address health inequalities, following its experience of working with integrated data during the COVID-19 pandemic. 

ICSs are partnerships of organizations that come together to plan and deliver joined up health and care services, 42 of which were established across England on a statutory basis on 1 July 2022. The purposes of ICSs include improving outcomes in population health and healthcare; tackling inequalities; enhancing productivity and value for money; and helping the NHS support broader social and economic development. 

With the establishment of the ICSs last year, NHS England is now thinking through the role of integrated data and population health analytics - particularly in terms of how they can improve health inequalities. NHS England said: 

Data-driven population health approaches will be a key tool in our response to these inequalities. The challenge for ICSs will be to quickly develop their use of population health analytics, from using data to inform their approach to condition management, to utilising predictive risk factors that help to increase early detection and prevent ill health.

Person and pathway centered datasets, including information about the wider determinants of health, are needed, as well as the analytical teams and data-literate leaders that can make use of them.

These approaches are needed now more than ever, not only to target health inequalities and variation in care quality at a local level, but also to help systems to make the best use of their collective resources and to track and measure outcomes in more tailored and effective ways.

NHS England explained that the COVID-19 pandemic has taught it a lot about how data and intelligence can be used to address urgent needs, particularly with regards to addressing the needs of different communities. 

For instance, data helped the NHS identify those that were most vulnerable to COVID, helping it build a more effective shielding list and prioritize vaccinations, and also helped teams find and support specific groups. diginomica has covered extensively how the use of data during the pandemic changed the way that healthcare provision was thought about, particularly as it relates to local requirements. 

The end goal for NHS England, which it has stated previously, is to deliver personalized, integrated care. It added: 

Population health analytics should be used within a wider population health management (PHM) approach that not only ensures groups most at risk of ill-health are prioritized to receive preventative care, but also supports clinical and care staff in place-based teams to design and deliver new integrated care models that are tailored for these at-risk groups.

These local teams can only do this if they have a detailed understanding of their diverse communities that is not only informed by rich datasets, but also by qualitative insights into the needs and experiences of these communities. In order to achieve this, analytical, information governance and data security teams must take steps to ensure their use of data is lawful and transparent, complying with relevant legal requirements to respect the rights of individuals. This should allow local teams to gain and maintain the trust of patients and the public in safeguarding their confidential health and care information.

Building the foundations

The guidance published by NHS England is essentially a set of principles and components, rather than a prescriptive vision or set of national ‘must dos’. However, ICSs will be expected to do the following in the short term: 

• During 2023, put in place cross-system information governance arrangements, particularly between primary and secondary care and local government partners, that enable the safe and timely flow of information across the ICS and support the integrated care board (ICB) to deliver its functions.

• During 2023, appoint a chief analyst (or an equivalent role, such as chief data and analytics officer) to lead the intelligence function, supported with the responsibility for putting in place clear reporting arrangements into ICB, integrated care partnership (ICP) and place-based decision-making forums to ensure insight into population need is informing local strategies and transformation priorities.

In terms of what NHS England perceived an intelligence function to be, it describes it as: 

A system-wide, multi-disciplinary collaboration of intelligence professionals, with representation from analytical leaders and key teams across the whole ICS. At its core, it is a way of co-ordinating a diverse range of analytical skills to support the needs of the system.

The purpose of the intelligence function is to ensure that decisions across system, place and neighborhood teams are routinely informed by evidence that is tailored to the local context, including a detailed understanding of health inequalities between population groups, and that the system is supported to take a population-based approach to care planning and delivery, including the use of data to shape the personalisation of care.

While it may have its initial basis within core teams in the ICB, the intelligence function should be collaborative and multi-organisational, comprising analysts and other insight specialists from all constituent parts of the ICS – including NHS provider organizations, local authority care services, public health teams and voluntary sector partners – and serving the strategic goals of the ICP.

There are also a number of other NHS projects taking place that will form as national enablers to these intelligence functions. These include: 

• A federated data architecture - NHS England is currently developing a federated data architecture and a common data platform. As such, systems will need to ensure that their local data infrastructure and functionality complies with the national offer and is consistent with national standards. 

• Secure data environments - NHS England is also changing how NHS health and social care data is made available for research and analysis. It published guidelines for secure data environments late last year, which underpin how people and organizations access health data for research and analysis. 

• Information governance and privacy - a information governance framework for integrated health and care has been published, which provides guidance on the use of confidential patient information in shared care record systems. However, NHS England notes that analytical leads will need to work with local information governance leads to ensure that they have a legal basis for using confidential patient data. 

My take

A principles-based approach focused on catering to local needs and improving health inequalities is a strong pitch - and one I’m pleased to see. The NHS has stumbled in the past when it comes to data projects, but this level of transparency around delivery is welcome. What’s clear, given the pressures facing the NHS in recent years, is that as well as appropriate funding, the health service needs a smarter approach to delivering outcomes.