The government’s requirement for the integration of health and social care services is not about improving care or the patient’s experience. It is instead a concern about inappropriate hospital admissions and delayed discharges; money and performance masquerading as care and compassion.

‘I repeated my story three times to three different members of the same integrated community health team’

Hospitals think community health services made up of GP’s and district nurses could do more to prevent hospital admissions and they think social services are responsible for people staying in hospital longer than is medically necessary while care arrangements are made. The evidence does not support either of these claims but hospitals find them convenient excuses for exceeding budgets and failing to hit waiting list targets.

As to the claim that enforced integration is justified on the grounds of improving service coordination and communication so individuals don’t have to repeat their story, well that implies these problems don’t exist in an integrated service.

A matter of urgency

Feeling unwell and having got worse over the weekend I rang my GP surgery as soon as it opened to ask to see a doctor. When I got through the receptionist told me all the appointments for that day were taken. Was it urgent? I knew from experience that if I failed to convince her I would be offered something next week by which time I would be better or in A&E.

I played my trump card: my quadruple heart bypass. The receptionist said she would arrange for a GP to ring me to decide if I needed to see a doctor. She asked for my details name, address, telephone number and symptoms “to brief the doctor”.

An hour later a GP rang and asked how he could help. I gave a brief medical history and my symptoms he asked if I smoked, what type of work I did and what exercise I took. He made an appointment for me to see a nurse that afternoon at their other health centre. The nurse asked me what seemed to be the problem, I gave her a brief medical history and described my symptoms she listened to my chest and issued a prescription for antibiotics.

Aside from the superficial nature of my medical assessment, I had repeated my story three times to three different members of the same integrated community health team.

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