Empowering local decision-making: Technology for a devolved NHS

The establishment of Integrated Care Systems (ICSs) across the UK marks the most profound structural shift in the NHS for a generation.

It’s a transition from a centralised, command-and-control model to a devolved operating model based on subsidiarity, collaboration and local autonomy. This change empowers local leaders in Integrated Care Boards (ICBs) and Trusts to make strategic commissioning decisions, allocate resources and design services that directly address the unique health needs of their specific populations.

The philosophy is sound: a one-size-fits-all approach can’t effectively serve the varied demographics, geographies and health challenges found across the country. Success relies on allowing ICSs the freedom to achieve nationally agreed outcomes in the most effective way for their area.

However, this devolution creates a complex technological dilemma. How can a system grant flexibility and local innovation while simultaneously ensuring consistent, high-quality standards, security and seamless data exchange across the entire ICS and the national service? 

The answer lies in adopting technology that’s inherently modular and interoperable — a digital framework that empowers local decision-makers without compromising system-wide integrity. 

SPARK Fusion® is this essential framework.

The technological paradox of devolution

Integrated Care Systems are tasked with delivering four core purposes, including improving population health, tackling inequalities and enhancing productivity. To achieve these, they need two things that often appear to be in conflict:

1. Local flexibility: The ability to rapidly develop and deploy specific digital solutions for place-based or neighbourhood-level challenges (e.g. a specific remote monitoring tool for a rural population or a targeted patient engagement portal for a socially deprived area). This aligns with the introduction of Earned Autonomy regimes.
2. System integrity: The assurance that any local innovation adheres to national standards (such as FHIR or HL7), maintains data governance and contributes to the system-wide longitudinal patient record.

The danger of unmanaged devolution is the risk of digital fragmentation, where every Trust or place-based partnership builds its own siloed solution, creating new boundaries and inhibiting the very integration ICSs were designed to achieve. 

To avoid this, the NHS needs platforms that are standardised at the core but flexible at the edge. SPARK Fusion® offers the flexibility to customise solutions per ICS/Trust and provides modular services.

SPARK Fusion®’s modular architecture: The foundation of local choice

SPARK Fusion® is built on a modular design principle that directly solves this paradox, providing ICBs and Trusts with the autonomy they need while guaranteeing system-level compliance.

1. Modularity for local customisation

SPARK Fusion® isn’t a rigid, monolithic EPR replacement. Instead, it’s an adaptive layer composed of interconnecting digital components (modules) that can be selected, configured and deployed by local teams to meet their specific needs.

1. Adaptation at place and neighbourhood level: A local authority and a Primary Care Network (PCN) within an ICS might collectively decide they need an enhanced digital triage module and a patient survey tool for their neighbourhood. With SPARK Fusion®, they can deploy just those specific modules, integrating them seamlessly into their existing local systems without requiring an expensive, system-wide overhaul. This ability to tailor solutions without compromising integration is key to the ‘devolved operating model’, supporting place-based joint working and aligning with local authority boundaries.
2. Rapid deployment and iteration: Because the core infrastructure (security, data standards and user identity management) is provided by the SPARK Fusion® platform, local teams can focus on rapid innovation — building and testing new care pathways (e.g. virtual discharge processes or patient feedback loops) in weeks rather than months, accelerating the pace of transformation and supporting the move towards change-led improvement.

2. Maintaining compliance and data continuity

The greatest barrier to devolved digital transformation is the fear of non-compliance, particularly around clinical safety and data governance. SPARK Fusion® mitigates this risk by standardising the complex, non-negotiable elements.

1. Interoperability by design: The SPARK Fusion® platform mandates the use of open standards, such as FHIR (Fast Healthcare Interoperability Resources) and adherence to the national data standards directory. This means that whether an ICS uses SPARK Fusion® for a patient portal, a staff workflow tool or remote monitoring, the data produced is inherently structured and ready to be shared with other systems. This adherence to national standards ensures data continuity and the ability to have a single, coherent view of the patient across all care settings, regardless of which Trust or community service is interacting with them.
2. System-level governance: Compliance (including IG, cyber security and data protection) is handled at the platform level. This relieves individual Trusts and local teams from the burden of repeatedly proving compliance for every new digital initiative. ICBs and Trust boards can be confident that while exercising local autonomy, they’re building their solutions on a foundation that meets the highest standards for information assurance and clinical safety, ensuring they’re driving the digital agenda responsibly.

The impact on leadership and efficiency

For C-Suite roles, including CTOs and CNIOs, SPARK Fusion® provides a strategic advantage. It allows them to devolve tactical decision-making to the teams closest to patient need, while maintaining strategic control over data quality and system integrity. It shifts their focus from managing fragmentation to leveraging data for strategic commissioning.

This devolved approach leads to:

1. Reduced duplication: Instead of 10 Trusts within an ICS independently procuring and deploying different, incompatible discharge systems, they can all implement the SPARK Fusion® platform and customise the discharge module to their local needs, consolidating infrastructure and driving greater value for money. This helps systems achieve the efficiency, transparency and financial resilience they need today.
2. Accelerated transformation: Local teams, equipped with a safe, flexible and pre-compliant platform, are empowered to become ‘change agents’, leading bottom-up improvement that’s responsive to the needs of local communities, rather than waiting for centrally dictated actions.

By embracing modular technology that balances local autonomy with system-wide standardisation for compliance, the NHS can effectively deliver on its devolved operating model, ensuring local decision-making drives real-world transformation, not digital chaos.

Some providers will even evolve into IHOs holding entire health budgets for defined populations, a shift enabled by SPARK Fusion® for financial and productivity metrics.

Ready to empower your local ICBs and Trusts? Download our guide for the practical, modular technology roadmap needed to deliver the devolved NHS 10-Year Plan vision today.