Features: October 18th, 2013

Pressures to integrate health and social care are steadily rising. Increasing life expectancy, the ability to treat more conditions and unsustainable cost rises are driving the rethinking process. In this article Simon Morioka explains how a range of partners are pioneering ways to achieve better co-ordinated person-centred care.

“Integrated Care” has become the buzz-word in health and social care circles, successfully fuelled by the Department of Health’s invitation to local areas to become health and social care integration pioneers, and the subsequent announcement of the £3.8 billion Integration Transformation Fund. Nevertheless, the question of how better co-ordinated, person-centred care will work at scale is still very much in the process of exploration, rather than coming with a ready set of answers.

It is with this end in sight that the LGA – alongside national partners including the Department of Health, NHS England, Public Health England, Monitor and the Association of Directors of Adult Social Services – has commissioned the Integrating Care team to develop a toolkit to help local authorities and their health partners make better co-ordinated, person-centred care an everyday reality.

The integrating care programme

Integrating Care is a specialist team made up of senior health and social care leaders, managers and professionals working in the UK and internationally. The team have been working alongside the LGA to create with local areas an integrated care “toolkit” to support the development of better quality, integrated care across whole localities.

The programme recognises that toolkits have had a poor reputation for driving and supporting change within the public sector. There is unlikely ever to be a “one-size fits all” model for integration across different patients and service user groups, and across different areas of the country. However, many areas have already made good progress in transforming the way health and social care work together with individuals, their families and carers.

Pioneering in Torbay

Torbay provides one such example. This area on the south coast of Devon has a significantly higher than average number of residents over retirement age. It was therefore clear a decade ago that the major service question was how best to meet the requirements of the rapidly growing number of people with a complex mix of health and social care needs. Joint work between Torbay’s health and social services began back in 2002, and led in 2005 to the establishment of a Care Trust. The Care Trust used a fictional 85-year-old patient – Mrs Smith – to create and develop a service model designed with the patient at its centre. It uses integrated, multi-disciplinary teams working closely with primary care providers to emphasise the promotion of independence, the provision of services in people’s own homes, and speed in the identification of and response to a patient’s needs. The benefits of this approach have been evidenced in patient satisfaction, in the job satisfaction of the services’ workforces, and in increased operational and financial efficiency.

The characteristics of co-ordination

Using exemplar cases like this, and building on the collective experience and knowledge of the team, Integrating Care is working to distil best-practice so as to accelerate development and provide much-needed substance to the case for new models of care.

In part this has involved a recognition that across the UK and internationally there are a number of key components that characterise better co-ordinated services. These components encompass the ways in which we identify needs, how we work with individuals and across the professional spectrum to develop care plans, and how we link up funding and resources to deliver upon those plans. Whilst innovation always entails a degree of risk – and it is early days in many areas of the country – from Torbay to Cumbria and Greenwich there is a growing body of evidence that such services really do deliver better outcomes, and in a more financially sustainable way.

While the desire to switch investment away from expensive acute services to preventative care is age-old, there is now increasingly a political and professional consensus that by working together, health and social care services can make a real difference to the lives of those in greatest need. And whilst this is unlikely to be a panacea for all of the pressures on the health economy today, it offers a specific and actionable way of improving quality and reducing cost. When combined with similarly co-ordinated interventions in the realm of broader public health, this could at the very least put us on a more even keel in the years ahead.

Overcoming integration barriers

Few would argue with the need to help those with long-term physical and mental health conditions to maintain their independence, or with the need to enable individuals and carers to take greater control of their own health and wellbeing. However, there remain a number of practical barriers to be overcome.
Through workshops held across the summer in London, Leeds and Bristol, a national community of practice has been developed to look at both key opportunities and challenges to integration. As a result, groups of local authority and healthcare professionals are now actively engaged in working with national public sector bodies and patient representatives to understand exactly how we can overcome these barriers.

Whether in the areas of modelling the effects of new care-structures on activity levels within different care settings, of understanding how joint commissioning works in practice, or of exploring what it means to bring together professionals on the ground, the “value case” for integration is being crystallised at scale and pace – with an objective of getting concrete advice and guidance to every Health and Wellbeing Board by December 2013. And whilst the Health and Wellbeing Boards in many areas remain very new, there is an emerging and strong will at a local and national level to use these platforms to drive improved area planning, as well as to better co-ordinate operational services.

Whatever term we use to describe better co-ordinated, person-centred care – and the underlying principles are not new – there has rarely been a more important time to translate theory into practice. ‘Integrated care’ is a practical response to a series of growing pressures on the current system, already evident in A&E departments across the country, that is first and foremost about improving the health and wellbeing of millions of people nationwide. The UK’s health and care systems, which have received significant investment over past decades, are in many ways a victim of their own success. We are living longer, and more and more conditions are becoming treatable. In the UK, approximately one-third of the population now live with a long-term condition; these patients account for more than 50% of all GP appointments, 65% of all outpatient appointments and over 70% of all inpatient bed days. The reality is that our current twentieth century models of care, for all their failings, have achieved huge advancements in the support of those in need. But they must continue to develop and evolve if they are to address the challenges of the twenty-first century.

Simon Morioka is director at Integrating Care and managing director of PPL
Integrating Care is a team of senior health and social care leaders, clinicians, academics, practitioners and transformation professionals, chaired by Sir John Oldham OBE.