The term integration is one that is used regularly in all parts of the health and social care system. Politicians and health and social care leaders love talking about integrated services, and these terms drip off the tongue very lightly. However, the reality is that integration is complicated to deliver, and in my view, we are starting a conversation about integrated services from the wrong place.
When I talk to politicians or system leaders, they always talk about the NHS, local authorities, and sometimes even care providers, but this misses the point. The accurate measure of successful integration is how the person who uses the service experiences it. If we are going to move towards true integration, we have to shift our mindset from organisations and processes and think about people and outcomes.
This brings me to one of the most challenging barriers to integration: the measures of success. Our current system is driven by different measures of success, separated budgets, and sometimes conflicting objectives from the various organisations that are supposed to work together. We will never get an integrated system that focuses on people and outcomes when we have different visions and different measures from different bits of the system.
I think it’s also important to recognise that the road to integration is a very well-worn path littered with examples of failure. I can remember coterminous systems, joint appointments, PCTs, Health and well-being Boards and CCGs, to name a few, all of which were supposed to be delivering the outcome of an integrated system and all failed. I think they should send a clear message to the Government that the route map to an integrated health and care system will not be a structural change. There is something far more fundamental that is needed if we are going to ensure we have an integrated approach that enables people to live well and to have the support needed to have choice, autonomy, control and independence.
The biggest challenge we face is a cultural, not a structural one. The NHS and the public sector are generally driven by various negative cultures that do not facilitate change. The way in which the NHS constantly perpetuates itself and does not look to others to deliver solutions is a significant impediment to an integrated system. I was struck by a conversation I had in America with a respiratory consultant who could install air conditioning in the homes of his poor patients to stop them from going into crisis during the incredibly hot New York summer. This is an excellent example of something integrated and focused on outcomes, not organisations or processes. This would never be able to happen in the NHS or our current system because people would talk about the money flowing out of the NHS to a private air-conditioning firm. Still, the critical point here was that the patient had a better quality of life and did not go into a crisis which needed acute interventions. When I see the UK system responding to people’s needs in this way, I will then believe that we have a truly integrated, person-centred, outcome-focused approach to health and social care. My experience tells me this is a long way off, and I am not sure I will ever see it in my lifetime.
@ProfMartinGreen
@CareEngland
