The jargon of 'integrated care' is much-used in health policy and management circles. But why does 'integrated care' matter? And what will it mean for patients? This short animation aims to bring integrated care to life for anyone involved in improving patient care. If those working towards integrated care can share this vision with others in their local health and care system, then there is a real chance they can make integrated care happen.
There was no help and he died 4 years ago. But, no one has done anything wrong! It is useless to complaint to PHOS or LGO, they simply close ranks.
What is sad is to see things fragment because of insufficient time and lack of shared information http://www.docrick.co.uk/Medical_practice/Commissioning_Pathways_of_Care/
Point taken. You clearly have a great deal of expertise and experience in this field and I respect that. We also had a twitter comment to the effect that although we had acknowledged Sam's bereavement and possible depression we hadn't explicitly mentioned mental health services. Ultimately we wrote the animation to illustrate what person-centred co-ordinated care is all about and why "integration" should be based around the person not structures or money. Even though we put a great deal of effort into getting the story right (and I am myself a consultant physician who deals daily with patients who have chronic lung disease and often refers to respiratory CNS for domiciliary oxygen) it is inevitable that people with specialist knowledge might find fault with elements of the story. But the point is the Big Picture around people with multiple co-morbidities using multiple services and in the first half of your post you do acknowledge that it does this well. Feel free to attend our conferences on 22 October on services for older people and on 25 October on care co-ordination
One person has said we ignored the importance of good mental health (we did not. It was clearly mentioned that Sam was bereaved, sad and socially isolated. Albeit we didn't explicitly mention specialist mental health services, most depression/anxiety/loneliness is dealt with in primary care)
Another has said we have represented a move to nursing and residential homes as something to be avoided at all costs. (We did not, we just tried to offer Sam alternatives to long term care so he could stay at home as he wanted to. Maybe he will need a care home in the future but not before he had been given the right supports to try at home)
Someone else has mentioned short burst oxygen therapy but we didn't specify whether it was long term or short burst, just that he was supplied with Oxygen
A couple of people have mentioned that perhaps the care co-ordinator shouldn't be a district nurse because the district nursing workforce has suffered reductions. Understood. but if we had said that the co-ordinator was a community matron, nurse practitioner, someone from the voluntary sector etc we would have had the odd critic there too.
The main thing is the "big picture" for joined up, person centred co-ordinated services for Sam and people like him. I am a consultant geriatrician and no-one mentioned us either, but I am not objecting. No slights intended to any profession or discipline but you can't mention everyone in 3 minutes
Is it really beyond us to put a simple system in place along the lines of the animation - or do we tend to concentrate on the difficulties??
Cllr Jonathan Owen
It makes me a wee bit uncomfortable in terms of he health side of things as I feel very strongly that the social model thinking should very much be at the fore of integrated care. It a bit hard given the medical interventions people with long term conditions have in relation to their health. So I am just being picky I think.
Anyway, it's great and I am about to pop a link to it up on the Patient Opinion and Care Opinion blog pieces on integrated care.
Speaking of which, I give some of my own musings as a service user on what is happening in my own City Sheffield on the Care Opinion blog. There are some good things helping me in terms of integrating the services I use. Better still, I understand that Sheffield are to look at integrated care and pooled budgets as the future means of combating the lack of centralised Government funding and a need to diversify and create solutions. Most local people are enthusiastic about the pooling of budgets and the move, that is being led by the City's Health and Well Being Board, is one of the few positive happenings that has come from Government reorganisation of health services, commissioning and responsibilities for public health.
Please do take a look at what we are doing at Patient Opinion and Care Opinion and encourage the people you represent to contribute on the link below or take part yourself. You can also follow us on Twitter @careopinion
Trying to co-ordinate my parents' care takes several hours of my time every week, it is in effect a second job. It's proved incredibly difficult to find out what's available and even harder to get it.
The district nurses I've dealt with have been amazing but their caseload is ridiculous and they can only dream of being able to provide the service Sam receives.
Mobile access to integrated records is also an urgent requirement to support integrated care. Whilst I absolutely support DNs fulfilling this role, I think it is vital that the 'key worker' role should be fulfilled by the most appropriate clinician for the individual, in partnership with any family members able & willing to be involved.
Before that the community (especially district nursing and social work) did all the things you talk about and most of the staff still do, but in a system ruled by mechanistic old industrial ideas of control centred on Leaderism based in a hospital or a Council Chamber.
Give it back to the practitioners, they know what to do.
I have worked as a carer for about 30 years and have since the different care that has changed in the years but it has still not got the correct system going in the community to keep people out of care homes and hospitals we as STEPS are support to give that 6 weeks period to help stop the bed blocking in the hospital and give people a change to stay home but as the government have still not worked this out it is getting harder and a strange on communities staff and services users we as a service would like to have the funding to provide a safe warm good and caring support for people please help us thank you Janelle Cradduck STEPS carer
In the system we have now we can make some small changes to great effect
Night time can be a nightmare and the tipping points are numerous A commissioning change to empower the ambulance paramedics to make a different decision (assuming Sam was not acutely unwell when he called and they arrived at his home) as well
as funding a night sitting service linked to the ambulance service and funded by the CCG who when called by the ambulance service (who might have to wait till they came) would mean someone to be with Sam to settle him to sleep and even stay overnight to diffuse his tipping/crisis point (assuming he calls when it’s late in the evening as some evenings the emotional pain is intolerable) This would start to provide a new set of choices for Sam and for the ambulance service
In the system we have now this would divert these understandable unplanned admissions
If Sams symptoms are both emotional and physical Expanding the brilliant fatigue anxiety and breathlessness programmes run by well-being centres in more and more hospices would mean the night sitter could talk to Sam about help with these hideous symptoms and a new and appropriate network of support would open up for him
Many hospices and NHS respiratory services have strong partnerships and early referral to these courses is life changing Many Hospices and NHS mental health services have great partnerships balancing excellent bereavement care with treatment for depression
When we have an ordinary human experience of pain by adjusting the systems we have now everyone has the potential for a better experience and a more cost effective experience Small productive changes like these using funding in CCGs that they get back by reassessing the volume of unplanned admissions and the activity levels in acute beds in many localities would add up to a significant system-wide improvement