Making integrated care happen: a marathon not a sprint

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I spend a lot of time out on the road speaking about integrated care, but it can be really difficult to explain in a nutshell to a range of different people what it really means and just how important it is.

Today we launch an animation that aims to do just that. To adapt a well-worn phrase, we hope the animation is worth a thousand words in bringing to life the meaning and importance of integrated care in a way that endless definitions can never do.

Our animation is being launched shortly before Norman Lamb MP announces the areas of the country selected to participate in the first tranche of the government's integrated care pioneer programme. The Minister's announcement will be an important staging post in the journey towards integrated care that began with the Fund's contribution to the government's listening exercise in 2011. To revert to another well-worn phrase, this journey is a marathon and not a sprint, and much remains to be done to convert aspirations into practice.

Our view at the Fund is that priority now needs to be given to putting in place policies to support integrated care, and offering practical help to enable providers and commissioners to take integrated care forward at scale and pace. Policy developments must encompass changes to financial flows to remove perverse incentives such as Payment by Results and ensuring that market regulation does not inhibit collaboration between providers. These developments are essential in creating the right environment for the integrated care pioneers and to support the emergence of more joined-up services for vulnerable older people.

Practical help should involve providing local leaders with the skills needed to put in place new models of care, learning from international best practice. A great example is the story of the Canterbury District Health Board in New Zealand as set out in a paper we published recently. Canterbury has made progress towards integrated care over several years by investing in its staff and supporting them to bring about improvements in care. Its experience is an example of achieving change 'from within' instead of relying on external factors like top-down targets or competitive pressures.

Canterbury's story is just one of more than 20 UK and international case studies brought together on our new integrated care map, which illustrates how innovators in the NHS, local authorities and the third sector are making real progress in overcoming fragmentation of care and strengthening care co-ordination. These examples show that integration is gaining traction as providers and commissioners seek to find local solutions for people with complex needs.

The essential ingredient in making integrated care a reality more widely is leadership at all levels − from frontline teams through to NHS boards and in national bodies such as NHS England, Monitor and the Care Quality Commission. The Fund is making its contribution to leadership development in a new programme on collaborative leadership designed to support leaders in the NHS and local government to work with their peers in local systems of care. We shall shortly be announcing plans to work in depth with four communities over three years starting in 2014 and will be inviting expressions of interest. Watch this space.

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Deirdre Criddle

Complex Care Coordinator,
CoNeCT - SIr Charles Gairdner Hospital
Comment date
29 September 2013
Working across transitions of care, finding like-minded healthcare professionals willing to help people with complex chronic conditions is the first step. Helping people with complex conditions and their carers to find their " local support team" is the next one. Funding the navigators- complex care coordinators - is problematic for siloed healthcare systems and challenges usual care and funding? power? of institutionalised care. There will be a lot of barriers - people who feel their role in patient care is being challenged. The need for open communication underpins the role of care coordinators. The imperative to be diplomatic as we try to change the nature of care for our complex clients and collect "true believers" must be understood by all who take on such challenges. Measuring outcomes with our colleagues in the research arena is the final jewel in the crown, and as Nick Goodwin has highlighted deserves our earnest attention. Just like our traditional healthcare system these outcome measures are based around single disease states and are just as siloed. Finding validated tools which we can use across settings and indeed across countries will hopefully give care coordination the political grunt needed to "speak the truth to power"and fund the navigators to the level needed to change the way healthcare system function.

George Coxon

Various inc care home owner / MH clinician,
CCH Devon
Comment date
27 October 2013
After many years as an NHS commissioner and now working across health and social care I am more convinced than ever that KPOOH and GPOOH are the central elements that need to be tackled in the pursuit of better integration for services and viable care particularly for the frail elderly in older old age. With an NHS budget of circa £114b and a social care budget of closer to £14b. The continuing cap and squeeze on social care funding combined with an ageing population being supported to live with significant comorbidities at home by unsustainable care packages will perpetuate the volume of people being admitted to acute hospitals putting great pressure of costs and services not to mention the wellbeing and consequences of hospital care. Solution focused risk sharing health and social care alliances with independent care providers should be encouraged and trialled using some of the £3.8b transition funds. New ideas should be looked out in an open minded way with choice and best interests of the elderly in mind. Safe and fun for older people must be central themes. 24/7 care in environments that KPOOH and GPOOH That's keeping people and getting people out of hospital of course. As I'm sure you'd already worked out. !!!

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