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At The King’s Fund, we have long argued that care and services need to be better integrated around the needs of users. Yet the positive benefits of primary and community-based care co-ordination have yet to be universally recognised – especially in terms of cost-effectiveness and reduced hospitalisations. There is also relatively little evidence on how best to apply care co-ordination in practice. Without an understanding of ‘how to’ integrate care at a clinical or service level then even the best-laid strategic plans may come unstuck.
As part of our new Integrated Care Programme we are currently undertaking a research project on care co-ordination for people with complex chronic conditions funded by The Aetna Foundation. This work seeks to understand the key markers for success in care co-ordination and develop practical lessons for successful adoption. To support this, we are working with five demonstrator sites with a proven track-record in delivering effective care co-ordination. During the calls for application to be involved in this work, three things became clear about the state of care co-ordination in the UK.
First, there was considerable enthusiasm and interest in developing better care co-ordination for people with complex needs and in understanding how to bring the various components of care co-ordination together. However, there was a lack of understanding on how best to achieve this and a feeling that the projects were acting somewhat ‘outside the system’ and lacking legitimacy.
Second, the more established care co-ordination projects tended to be focused on implementing disease-based or clinical pathways – for example, for diabetes or arthritis – rather than taking a more holistic approach to co-ordination of care and services for people with multiple health and social care needs. Care pathways are the mode de jour, but have limitations when faced with the need to support the increasing number of people with multiple issues.
Third, despite many innovative primary care-based approaches to care co-ordination, a chronic lack of attention is paid to the value of demonstrating or measuring outcomes. So, while many projects provided compelling patient or carer stories about the difference care co-ordination made to their lives, few projects used client feedback pro-actively to help them reflect on the care services they provided. Information on care outcomes, whether on a patient or carer's ability to better manage their anxiety, on their physical functioning or chronic illness was not routinely collected. Even information on changes to the utilisation and costs of services remain rudimentary. This suggests two things about the UK care system: first, that the business of measuring and monitoring outcomes is not strongly valued (culturally or managerially) as a way of judging service performance; second, as we found in our GP Inquiry last year, health professionals are not predisposed to using such information as a means to drive improvements in quality.
There is ample evidence globally that care co-ordination has the potential to bring significant benefits to patients, carers and service users. However, there is rather less about how to develop such approaches successfully in practice. Unless we are ready and prepared to invest in this approach, and to examine the outcomes of the many innovations in care co-ordination that exist in the UK and other countries, it will continue to be on the fringes of activity rather than being the main event. It’s time to demonstrate the value of care co-ordination.