We use cookies.

To make your experience the best it can be, we use cookies and similar technologies on our site. We need your permission to allow these technologies, which will maximise browsing experience. For more information on how we use cookies and how to change your cookie settings, please see our cookies and privacy policy.



Please complete this short form to get in touch with a member of our team and we will get back to you as soon as we can.



Sign up to our newsletter by completing the form below.

Header image for the current page Delivering a strategic data and analytics platform to enable system-wide population health management

Delivering a strategic data and analytics platform to enable system-wide population health management

Share this page

Mid and South Essex ICS and Arden & GEM describe how they have taken a multidisciplinary team approach to co-design a strategic data and analytics platform which provides staff across the ICS with the intelligence needed to plan and deliver priorities, using population data to enable more informed decision making.

When Mid and South Essex ICS was established in July 2022, it wanted to build a better understanding of its residents to tackle health inequalities, improve health and wellbeing, and reduce reliance on hospital care. This meant improving its data and business intelligence capability to enable a system approach to capturing, analysing and using data, incorporating the wider determinants of health.

Mid and South Essex ICS covers a population of 1.2 million people, bringing together over 149 GP practices, 27 PCNs and seven district and borough councils, with community and mental health providers, a multi-site hospital trust, ambulance trust and voluntary and community sector associations. Different partners were using separate data sources, flows and reporting systems while data analysis was being done in organisational silos.

This gap was outlined in the Mid and South Essex ICS Business Intelligence (BI) Strategy, which highlighted the need for a system-wide approach to capturing, analysing and using data through a collaborative data platform – a virtual BI hub – to meet the ICS’s overarching vision of having a ‘single source of truth’ and building a single, holistic view of its residents. No single platform existed to enable the ICS to do the integrated analytics required, which meant building a new platform to meet local needs and integrate with national data.

Building the system

In scoping what was potentially a vast project, we focused on the problem we needed to solve and the critical success factors. We needed:

Building something that would be fit for purpose, intuitive and robust required the right mix of roles, skills and representation across the system. Digital and data leads from system partners were invited to a data summit to share information, discuss projects and priorities across partners, and understand each other’s data and intelligence needs. In total, over 70 people have been involved in the project.

This collaborative working is maintained through a monthly BI and Data Delivery Board, involving operational and digital leads from all providers, to support ongoing development and build understanding in how the platform can be used.

National and local data
The platform, named Athena, has around 12 billion rows of pseudonymised data from national and local data flows, using cloud technology to bring together multiple data sources from primary, secondary, community, social and mental healthcare. This provides a holistic view of residents and an end-to-end view of patient journeys. Arden & GEM analysts build content for the platform at scale, enabling the ICS to benefit from national data and reporting dashboards alongside bespoke local analysis. Crucially, the data is managed through the same platform, giving system partners complete confidence that data sources are consistent, regardless of the dashboard they are using.

Information governance arrangements have enabled advances in safe data sharing to support system-wide working. Previously, local authorities would have to apply for access to health data but with the Integrated Care Board (ICB) now the owner of whole system data – including education, crime, housing etc. – the ICB can sub license that data, in line with data protection legislation and best practice, to support service planning and delivery. This is particularly important in enabling population health management to provide robust insights which support targeted interventions for specific cohorts of patients.

Intuitive data

From the start we wanted to make this a system that teams would want and feel able to use. That meant designing dashboards which tell stories with data that people can engage with, interpret and manipulate to inform decision-making which benefits communities. Dashboards already available include:

We have implemented a supporting communications programme to show teams how to use the dashboards and make the data more accessible and include commentary within dashboards to guide users. By curating the data and delivering information in manageable, useable ways, we’re starting to build understanding and use of analytics within individual teams. The aim is that business users become more confident in analysing their own data and habitually using insights to inform decision-making, without needing to rely on specific support from the BI team.

Delivering better outcomes for residents

The Athena data platform launched less than three months ago and is already being used to support care planning.

To inform system-wide work on avoidable attendances at A&E, we are building a comprehensive picture of influencing factors, including how the patient arrived, why and how they were discharged. By combining acute, mental health, 111, ambulance and social care data, Mid and South Essex ICS has the insight needed to target interventions where they will have most impact.

The platform is also being used to support a strategic stewardship programme, looking at how we might shift resources around the system to optimise the quality of care people receive, and track the impact of any changes we make over time.

Next steps

We’ve come a long way in combining multiple data sets, but this will continue to evolve as more data is added to support population health management and service delivery. As we apply more advanced analytics, we will be able to focus on looking forward, making predictions about the future, such as bed capacity during the winter and optimising supply chains or workforce. Drawing on learning from other industries, we are keen to enable specialist software to integrate with the platform to enable scenario planning that is flexible and scalable – putting an end to reliance on spreadsheets!

But these advances bring their own challenges too. Integrated Care Systems are competing against multiple industries in sourcing new talent to support business and data intelligence. We will need to work smarter – not just at system level, but across the country – to minimise duplication and share learning to support better outcomes for our communities as a whole. By developing a regional data platform for Mid and South Essex ICS alongside a national platform to deliver NHS England data requirements, the foundations are in place which we can all benefit from.

By Aaron Atkinson, Associate Director of Business Intelligence at NHS Arden & GEM CSU; Stephen Gallagher, Director of Data and Business Intelligence at Mid and South Essex Integrated Care Board; and Mai Pham, Interim Programme Manager at Mid and South Essex Integrated Care System.

This case study was originally written for Healthcare Leader and can be read here.