The NHS will not survive the decade without a meaningful shift from hospital-based care to community-led, proactive and digitally enabled pathways. Digital transformation is the only route to making this shift at the pace required and ICBs play an essential role in enabling this.
Digital transformation includes things like the single patient record and NHS App - but critically, it's also the vital operational technologies that underpin the neighbourhood-based, multidisciplinary model the NHS wants to evolve into. These are the tools that increase productivity, strengthen clinical decision-making, improve access and free staff to focus on the work only they can do. The question is how the NHS can unlock these benefits at scale, and fast.
We all know the NHS has a history of generating pockets of promising digital innovation without creating the conditions for scale. The result is a familiar pattern: duplication, local variation and opportunities lost. If we want community services to absorb demand now falling on acute care, we must scale high-impact digital solutions across whole systems, not one provider at a time.
There's no shortage of recent national guidance recognising this that talks about improving productivity, shifting activity upstream and embracing digital tools. But, there's not much spelling out the ‘how'.
As responsibilities evolve, with digital functions shifting from ICBs to providers, neighbourhood integrators taking on greater co-ordination, advanced foundation trusts and IHOs widening their remit, ICBs remain the only part of the system structurally capable of commissioning digital solutions at scale, standardising requirements, aligning incentives and driving consistency across providers.
But the context in which ICBs must do this is exceptionally challenging. ICB remit, governance and operating models are still developing. This structural uncertainty and the movement of digital functions to providers risks creating a vacuum just as the NHS needs coherent, system-level digital commissioning more than ever. ICBs also need to re-imagine their role as strategic commissioners at the precise moment when their bandwidth, certainty and capacity are most constrained.
But the difficulty of this task makes it no less essential. Scaling innovation cannot be a distraction from operational pressures but rather a response to them. We cannot afford to miss opportunities to invest the cost of two people doubling the productivity of ten. But where are they?
Community services are a clear one. They're still (generally!) well behind acute care in their adoption of digital tools, but there are great chances to improve value for money and patient experience. In north London, our system-wide adoption of workforce scheduling platform Doc Abode is a powerful example. The decision to move to a single system, across four community providers, was not an easy one, and nor was the implementation straightforward, but we are already seeing the benefits.
Previously, our four providers had urgent community response teams, all of which relied on manual co-ordination to match clinicians to referrals via phone calls, whiteboards and spreadsheets.
Every partner could see the value and the case for change, but it wasn't easy. It required us as commissioners to play an active role in developing the business case, securing investment, facilitating procurement at scale and even hosting a jointly funded implementation post. It required frontline teams to absorb new workflows while managing caseloads at peak demand.
A single digital co-ordination platform has begun to unlock gains in speed, visibility and staff experience. With all providers on the same system, genuine cross-boundary working becomes possible. Early data shows urgent community response teams delivering twice as many contacts per person and avoiding thousands more hospital admissions.
Along with NHS Innovation Accelerator, we have developed a playbook that outlines a repeatable process ICBs can use to commission for innovation at scale. It offers practical steps for defining system-level problems, aligning providers, designing for scale from the outset and investing appropriately in implementation, adoption and continuous improvement. But, to achieve transformation at scale, local ICB action must be matched by enabling national policy. A national information-governance passport would cut through the duplication that currently slows adoption.
Regional evaluation support, delivered through Health Innovation Networks, could strengthen evidence generation, peer learning and market scanning. And national incubation and scaling support through programmes such as the NHS Innovation Accelerator would help accelerate the spread of proven solutions. With ICBs empowered to deliver across systems, perhaps the NHS will finally have the ability to scale what works, relieve pressure on hospitals and build an integrated, digitally enabled model of care fit for the next decade.
