Developing integrated care at scale and pace: time to make it happen

Comments: 3

At the request of Norman Lamb, the Care and Support Minister, The King’s Fund hosted a roundtable discussion with key stakeholders early in November to consider what needs to be done to make a reality of integrated care.

Participants at the discussion were clear that an immediate priority is to promote the widespread adoption of best practice. Examples include the use of care planning and case managers to help people with complex needs navigate their way around health and social care services, and provide a single point of access to these services. Increased take up of personal health budgets in appropriate cases will also help people to take more control over their lives, for example by accessing the support they need to live independently.

Another priority, already recognised by the government, is to develop ways of measuring the experience of patients and service users in order to assess whether care is co-ordinated around their needs. A person-centred measure of integrated care is urgently needed to understand how well services perform and identify priorities for action. Agreement is now needed on the survey questions that should be used to derive such a measure and how the results will be used to support improvements in performance. 

It is essential that organisations at a national level work together to support integrated care. There are encouraging signs in this regard in the work being done by the NHS Commissioning Board, Monitor and the Care Quality Commission to work towards a common approach and to engage with the Local Government Association and Public Health England in the process. The national policy framework on integrated care expected in the spring will provide a clear indication of how these organisations will work with each other and the Department of Health to turn the commitments on integrated care included in the Mandate into benefits for patients and users on the ground.

Participants at the discussion were clear that there is no one best way of developing integrated care and the emphasis should be placed on discovery and not design in taking forward policy in this area. There was strong support for the suggestion that integrated care should be developed at scale and pace by enabling a number of areas of the country to test out different approaches. These areas would be encouraged to innovate in the use of payment systems and contracting mechanisms, and they would be allowed to suspend rules that get in the way of progress.

The past decade has shown how care can be transformed when the commitment of politicians is joined with the actions of NHS leaders and the engagement of frontline staff. With long waiting times a distant memory, the challenge is to apply a similar approach to better meet the needs of the growing numbers of older patients and users with several co-existing medical conditions for whom effective care coordination is an overriding priority. The personal commitment of the Care and Support Minister and the understanding among NHS leaders and staff of the importance of integrated care means that this is a policy whose time appears to have come.

The King’s Fund will be playing its part by continuing to work with the Minister and other stakeholders to help turn aspirations into reality. Our priorities in 2013 include supporting leaders in a small number of areas to develop integrated care at scale and pace and offering a new leadership development programme focused on what it means to share leadership across a whole system of care. We shall also continue to propose changes in policy that are needed to remove barriers to integrated care, as in our recent paper on the need to move beyond Payment by Results through the use of capitated budgets and other incentives.

Comments

#19235 Jane maher
consultant oncologist and voluntary sector advisor
Macmillan Cancer support

Cancer patient experience survey a very good indicator of care integrated across health care organisations and good transition management. It demonstrates the value of large patient surveys as well as smaller real time data

#19236 Jane maher
consultant oncologist and voluntary sector advisor
Macmillan Cancer support

Cancer patient experience survey a very good indicator of care integrated across health care organisations and good transition management. It demonstrates the value of large patient surveys as well as smaller real time data

#20998 lisa
commissioning manager-long term conditions
NHS Nene CCG

I welcome your discussions on developing integrated care, and from our own local experiences, concur. I am also excited at the national commitment to the work.

I work with a clinical lead, across two CCGs, and Northamptonshire's approach in 2012/13 has been about developing a robust 5 year strategy and vision, along with supporting the development of different models of integrated care across our localities. By working closely with our local partners we have secured a shared approach & which I refer to as 'being on the bus together' regardless of which particular stop you choose to get on at.

Northamptonshire is therefore on a journey, and we have been fortunate to work with the DH to support people with personal health budgets and will be taking this further in 2014/15. As we will be looking to develop evaluation tools on our work in 2013/14, through working with our local academic centre, we would be delighted to share our work with others, and provide opportunities to develop robust measurements that focus on the narrative of our service users experiences, and builds and designs an integrated commissioning route or routes that maximise outputs for a population.

Thank you.

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