Breaking down barriers through integration

There are lots of things that come and go in the world of health and social care. There are many of us who can remember the discussions about Dilnot, funding mechanisms, self-directed support and who can forget the hundreds of millions of pounds spent on clinical governance in the NHS. The new hot topic is integration and you can seldom attend a meeting about health and social care, without this word cropping up many times.

One of the major problems is that I do not think there is a unified definition of what integration means and for far too many parts of the system, the obsession is with the organisations and their survival rather than what they are delivering.

I believe a discussion of organisations and structures is to completely miss the point about integration. Good integration is measured by the experience of the person who uses the service, rather than how bits of the system fit together.

I often use the analogy of the airlines, where lots of organisations work cooperatively together to ensure the person who uses the service has a totally seamless experience. When I travel, I arrive at an airport, which is owned by one company, go onto an aircraft owned by another; I am then transported across many different international jurisdictions and then finally reach my destination.

The important thing in this analogy is not how many organisations are involved in delivering the service, the focus and the measure of success is the experience of the passenger. When I leave Austrian airspace and enter German airspace there is an enormous technical and structural transfer taking place, but as a passenger all I experience is a flight from A to B. This is the Holy Grail of integration and it should be how we measure our success in the health and social care system.

Of course, I am not denying that there needs to be better alignment between the organisations that exist in the system, but the focus of this alignment must be the outcome to the service user. I am of the view that we should all measure our success by three very high level but very useful measures.

The first is the person experience. How service users experience care and their satisfaction levels have to be one of the primary ways in which we measure success. The second measure has got to be the outcomes to the person, which any service intervention should be delivering. Services, care plans and support interventions must enable the person to live the best life that they possibly can, with as much choice, autonomy and control over how services are delivered. The third measure has to be about the effective use of resources; We have to ask the question, are we using all our financial and human resources effectively to deliver the required outcome.

Whilst I appreciate that these are very high-level outcome measures, I do think they enable us to have a shared view of what we are trying to achieve. One of the problems with our current fragmented system, is that it runs on so many different and sometimes competing outcome measures. One of the ways in which integration can happen is by clearly deciding what success looks like for everybody in the system. When you do that, you have everybody facing the same direction and being clear about what they have to achieve. There are some big challenges for health and social care and the only way we will be able to deliver the required outcomes is to work together to improve the lives of the people we support.




Edel Harris





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