Over recent years we have seen the rise of the term integration and you cannot go to any event or speak to a politician for more than two minutes before this word has dripped from their lips. I think we do need much more integrated services, but the first thing we must do is reclaim the term and place it squarely as the measure of success that is defined by the people who use services.
Whenever I attend meetings at the Department of Health and Social Care on this topic, they talk about the NHS, Local Authorities, and occasionally care providers, but what they never do is talk about the people who use services, or about how we measure the success of integration.
For me the success of integration should be measured by the invisibility of the organisations providing the support. To illustrate this, I always use an airline analogy. When I sit on a plane I do not know when I leave the Austrian airspace and go into German airspace, there is a massive organisational change going on around me but for me the measure of success is a safe and comfortable flight from A to B. This focus on the outcome to the passenger should be mirrored by the social care sector and health providers when they are talking about integrated care. It is the experience of the person who uses the service and how seamless that this is that should be our measure of success.
There are many impediments to the delivery of an integrated service and first amongst them is the cultures of the people and organisations that provide and commission the support. I have lost count of how many times there have been structural changes within our system over the last 30 years. I can remember Whole Systems Approaches, Joint Appointments, Co-Terminist Systems, PCT’s and CCG’s, (soon to be replaced by Integrated Care Trusts) but none of these structural changes have delivered what we need, and what we want. I believe partly it is because in all the changes, they never change the staff and the attitudes or the culture that lie deeply rooted within our current system. If one tenth of the money that has been spent on structure change had been applied to changing cultures, we would certainly be nearer to delivering integrated services.
I believe one of the biggest challenges to an integrated system is the fact that people are all working to different outcome measures. In future what we need to see is a clear approach to how we measure success and for that approach to be across the system and focused on the outcomes to individuals. I think we should work on three very high level measures of success. Firstly, the experience of the person who uses the service; does it provide what people need and want and do they feel that it supports them well. Secondly, the outcomes that are achieved. These can be either health or wellbeing or a range of measures that are important to the person who uses the service and helps them to live well maximising their autonomy, choice and control. Thirdly, we should examine whether we are using both human and financial resources effectively and efficiently. I believe if we work to these very high-level measures, we will start down the road to integrated services and stop focusing on organisations and processes and start shifting our focus to people and outcomes. When we do this, we will start to see the changes that are necessary to deliver integrated care.