Defining and delivering integrated care

Integrated care is a concept gaining significant and increasing traction within the NHS and the wider health and social care environment. The value of joined-up care now seems to be widely acknowledged by all of those organisations charged with delivering it.

What is not yet generally agreed, however, is quite what this means – let alone how to achieve it. What is integrated care? According to research by The King’s Fund, there are 175 separate definitions currently floating around. Little wonder there is such ambiguity around this critical subject, not least in the action plans being created to deliver it.

The value of recent work undertaken by National Voices on this topic is therefore considerable. This national coalition of English health and social care charities has worked to arrive at a definitive definition of integrated care.

Interestingly, its draft narrative actually suggests we dispense with the term. It favours “patient-centred co-ordinated care”. From the patient perspective, that means: “My care is planned with people who work together to understand me and my carer(s), put me in control and co-ordinate and deliver services to achieve my best outcomes.” It is a definition likely to be formalised in a common purpose framework due to be published next month.

‘There is no doubt that the current environment demands extensive collaboration between agencies’

National Voices’ definition serves to underline yet further the importance of achieving integrated care. There is no doubt that the current environment demands extensive collaboration between agencies. The new framework created by the Health and Social Care Act envisages CCGs integrating with local authorities as well as third sector organisations. Many of the 290 recommendations of the Francis report, meanwhile, focus on sharing information to drive optimal care.

Putting words into action

So with a definition of patient-centred co-ordinated care established, and the need for it undeniable, the challenge shifts to a fundamental one: how can we implement such an approach?

‘There must be a robust method of communicating among all stakeholders’

The answer will lie in getting the basics right. For any set of established groups to work together in an effective manner, there must be a set process in place for that collaboration. This process must be both best practice and consistently repeatable. Furthermore, there must be a robust method of communicating among all stakeholders. Health and social care is no exception in this regard. If we are to provide patient-centred co-ordinated care, the fundamental building block is clear: a framework that supports and delivers this sort of collaboration consistently.

Presented with this contention, managers at many organisations will swiftly and confidently reply that they already have just such a framework. They will point to processes and systems that enable multiple clinicians and parties to access information from multiple locations.

Yet to do so is to miss out a fundamental aspect of National Voices’ definition: the patient-centred part. Clinicians might argue that by making it possible to view images in multiple locations, PACS enables greater clinical collaboration and so better, faster outcomes for patients. Yet the reality is that such systems do not help patients move any faster through their journey across multiple organisations.

More than technology

Let us be clear: there is no doubt that technology is a solution to our co-ordination problems. The paperless NHS prescribed by Jeremy Hunt is absolutely the right answer to the question of creating integrated care, and it is achievable. But we must first ask ourselves exactly what the question is. Making messages and information electronic does not immediately make them up to date. Electronic week-old information on a diagnosis since superseded by another is just as unhelpful to a GP as the paper copy.

‘They must focus on establishing the basic inter-organisation workflows and pathways that will make co-ordinated, patient-centred care possible’

It is for providers to take a step back, then. Before anything else, they must focus on establishing the basic inter-organisation workflows and pathways that will make co-ordinated, patient-centred care possible. We must have a navigation tool; a way of joining up the best options for patients, wherever those options lie within the system; a way to match patient need with resource; a way to ensure that patients move smoothly from clinician to clinician, department to department with the minimum of disruption and their best interests clear and central.

Creating this navigation tool will be no mean feat. There are 220 CCGs, almost 160 hospital trusts and close to 200 private hospitals. The statistics in the social care sector are even more mind-boggling: in 2011, an estimated 22,100 organisations were involved in providing or organising adult social care. But if organisations are to deliver the quality of care rightly being demanded of them – the patient-centred co-ordinated care that patients, carers and regulatory bodies all now expect – it is a challenge they will have no choice but to meet.

Clint Schick is managing director of Strata Health UK