Integration is a question of balance

Much has been said about how service integration can be undermined by legacy attitudes and the preconceptions of the parties involved in the commissioning, funding and delivery of health and social care services. But attitudes and perceptions are changing.

‘We need to look at how we can change the way we do things to champion service improvement’

More and more people now accept that improved service standards and cost savings are not necessarily diametrical opposites.

By exploring the potential opportunities for service enhancement in times of austerity, Allied Healthcare’s workshop at the HSJ/Local Government Chronicle Integration Summit highlighted the substantial benefits that can be derived from focusing on what matters most when grasping the nettle of integration.

To look first at “service provision”, inevitable differences arise when the subject is viewed from the different perspectives of the various parties involved. This is not a constructive scenario for opening dialogue or fostering a broader understanding and appreciation of the diverse issues and responsibilities involved. As a result, it is easy for the existing “system” to restrict the ability to deliver what is in the best interests of a patient or service user.

Attitudes become even more entrenched when the subject is viewed from disparate financial parameters. Indeed, competing agendas and rivalries simply compound the difficulties. We should remember, however, the financial realities of austerity have been remarkably similar for all organisations involved every facet of health and social care. NHS foundations and non-foundation trusts, for example, collectively ended the 2014-15 financial year with a loss of £822m. Local authorities face a £1.1bn shortfall this year, having experienced a 31 per cent overall budget reduction since 2010. And 70 per cent of social care providers have not had a rate increase in three years.

We need a far more holistic viewpoint where all organisations involved in the care of individuals come together around the real needs of each patient and service user. To achieve that, we need to go back to what is really important: the wellbeing of those individuals who are in need of care and support, not just today but also in the future. In short, we need to look at how we can change the way we do things in order to champion service improvement.

Start here

The starting point has to be a very basic question - what do we mean by service improvement? Most people in the health and social care sector would agree that the ability to provide a coordinated service which meets the specific and evolving needs of individuals represents the ideal outcome. Certainly, patients and service users would always aspire to such personalised care. So an increasingly customer centred service model has to be our target.

Here, the priorities are quite clear - individuals want to receive a reliable, tailored, consistent, adaptable, high quality and affordable service where everyone is treated with the respect and dignity they rightly expect. There is no panacea and it is now clear that no single party in the field of health and social care has the entire answer. A broader perspective, greater teamwork and better understanding of the capabilities, limitations, and priorities of other organisations are required.

Workshop participants were encouraged to view the needs of an individual from different perspectives. Many references were made to the enormous costs associated with the admission of elderly people into hospital in the absence of practical and more appropriate alternatives. The case of patients with dementia was highlighted as an example where the disorientation of new surroundings and unfamiliar people in a hospital are likely to worsen rather than improve their condition. With specialist dementia care support readily available, they would be far better off in their own homes - and that would not only improve the outcome for the individual, but also save costs, reduce ambulance call outs and release hospital beds.

‘Providing a coordinated service which meets the evolving needs of individuals represents the ideal outcome’

Similarly, the loneliness felt by many elderly people is often a far greater worry than physical health issues. This can lead to frequent and avoidable direct demands being made on the health service. Here, the right care package and support from appropriate organisations would minimise “emergency” callouts and provide a far more effective solution for the individual, at any time of the day.

In addition to misplaced preconceptions, the workshop discussions also highlighted a fear factor in this process - a fear of relinquishing control and of introducing greater transparency with other third parties and external organisations. But it is only by sharing information and understanding just how effective other organisations can be in fulfilling the needs of an individual at different times in the care cycle that we really see the true value of integration.

And, as the workshop demonstrated, that goes for clinical commissioning groups, health trusts and councils as well as third sector organisations and service providers.

Matt Jackson is regional managing director of Allied Healthcare