Joined-up care: Sam's story

As an idealised design for a model patient, it's plausible. What we need now is real designs for real patients and to know how they cope with actual demands.

It would also be interesting to see some of the health & care costs associated with the different interventions in the animation.

Wish there had been joined up care for my son who had his pancreas removed. It was beyond the understanding of those who should have been there for him. He had childhood pancreatitis for 23 years and five major health issues including type 3 diabetes.
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.

well it sounds very good as it much better for everyone with patient at centre ,but in reality this is not so ,as yet happening in uk or we in post code lottery .

This happens in our area when the district nurse has time to co-ordinate care. The key is good communication, a named lead and sufficient time.
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/

Thanks for comments so far. First of all, Sam may be imaginary but I can tell you from 2 years as a doctor in the NHS and from members of my own family that the story of the problems he faces is all to real. If we had lifted the story from a real life patient it could have been identical. Second, we make it very clear in the voiceover that the kind of best case scenario can and does happen for some people in some places but needs to happen much more consistently across all localities and for all patients. We are very clear about this in the animation and various kings fund events. Third, with regard to costs and cost-savings, this is a very contentious area and a minefield. I suggest starting with the document "dealing with the downturn" 2009 by NHS Confed and the Nuffield Trust report on future health and social care funding and kings fund "health policy under the coalition government" and "transforming health and social care reports". I also strongly suggest looking at peer reviewed evidence from clinical trials, NICE guidelines, Cochrane reviews, robust peer reviewed case studies and not either marketing materials produced by providers with vested interests, nor from extravagant claims of cost-benefit by consultants being paid to deliver recommendations that people want to hear.

David Oliver

by the way - that was "25 years as a doctor" not 2!

david

Comment: Sam's Story Joined up care, excellent and accessible explanation of integrated care and using the term joined up care will help to open up the debate to a wider audience. Unfortunately the example does, I feel, over simply (perhaps it has to in this only 3 minute film) the management of emphysema (COPD) / breathlessness via the use of short bust oxygen. It is somewhat misleading that supplementary oxygen is effective in treating chronic breathlessness. In addition it rubs up against best guidance on prescribing home oxygen. Maybe a quick mention of cost effective interventions such as rehab services / patient support groups would have been useful (work by NHS London Respiratory team – including in DOH COPD/ Asthma Outcomes Document). Unfortunately in my working life in respiratory care the prescription of short burst oxygen does not remove breathlessness and the psychological barriers it sometimes brings. In conclusion it brings the debate over integrated care to real life.

Dear Will

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

David Oliver

I have just returned from Denmark where they truly believe in this stuff and far more importantly, they actually live and breathe it rather than just talk about it. As a result real benefits for patients are delivered and resources used more effectively. We desperately need to create an environment in this country where people are able and supported to deliver integrated care. Papers like these are useful, but we need leadership and confidence which appear to be in short supply right now.