How will we know integration of health and care services is working?

Listening to people and learning from their experiences offers the opportunity to change care for the better. Imelda Redmond, National Director of Healthwatch England, explains why involving users will give a better, bigger picture of how integration is working.

From a user perspective the health and social care system is often incredibly intimidating. On the surface we talk about it as one thing, one service working to provide people with the help and care they need to live well. But it doesn’t take long using it to realise that it doesn’t work this way. As we all know too well, it is a myriad of organisations, departments and professionals each delivering their own bit of the service, often under immense pressure and with little time to look up from the day job.

This has not been helped by performance-monitoring systems which often look at the delivery of care in particular silos, such as A&E four-hour waits or delayed transfers of care. Even patient experience research – such as the cancer patient survey – has tended to look at interactions with specific services. Very rarely do we take the time to step back and look at performance and experience across whole systems, this is despite ‘integration’ being a buzzword for probably the past 20 years.

Times are changing

But times are changing. New legislation will put integrated care systems (ICSs) on a statutory footing and shift the way we plan for and deliver health and care services. And with this change, NHS and social care services will have to reassess what good care should look like, particularly for people with multiple or complex needs stretching across a number of traditional service boundaries.

From a user perspective this can only be a good thing. We, at Healthwatch, often see that it is not the quality of individual services or the care provided by specific clinicians that people have issues with. It is the gaps between them, and the way in which they relate to their lives that make the difference.

Take for example getting to and from services. Whether it be about parking charges or access to patient transport, providing help to physically access care can be as much of a lifeline as the treatment itself. Likewise, admin processes, such as appointment booking, can either expect people to work round them, or they can plan for things like people’s caring responsibilities or better co-ordinate to reduce multiple visits to hospital or the GP.

There are macro benefits too if we get this right. Focusing on better experiences and outcomes for people in all their interactions with the system will help us get upstream by encouraging great focus on prevention and keeping people well.

Putting people at the heart of performance

It was really encouraging to see the NHS Long Term Plan set out a clear ambition to measure from patients’, carers’ and the public’s point of view, the extent to which local health services and their partners are genuinely providing joined-up, personalised and anticipatory care. This means the examples mentioned above cease to become issues on the margins of how the NHS thinks about care, but they are actually front and centre of current thinking.

But how exactly should we measure and track this in practice? That is the question Healthwatch, The King’s Fund, the Picker Institute and many other experts across the NHS, local government and the voluntary, community and social enterprise sector have been helping NHS England and NHS Improvement to grapple with.

And the simple answer is, there is no one way of doing it. This is going to require systems to deploy a range of methods and tools if they want to really understand what is going on. For example, quantitative methods such as citizens’ panels have a vital role to play in helping systems understand what isn’t working for people. Qualitative approaches, such as Health and Care Experience Profiles, can help us understand in much more detail the reasons why things aren’t working.

This is what the latest guide from The King’s Fund and Picker does. It brings all these options together to help system leaders understand what tools, and importantly what help and support, is out there to help them get this right.

Culture rules

Ultimately though, using the right tools is only half the job. This is going to be about having the right culture in place too. We need to create a culture that puts user voice at the heart of the new health and care landscape.

Those in charge of ICSs will need to spearhead this, leading from the front and ensuring that this new approach to assessing performance and improving experience takes top billing. They will have to bring together their patient experience leads with their comms and engagement people to form collaborative teams that are driving in the same direction and engaging with other departments and organisations within the ICS, with everyone thinking about what they do in the same way.

It has been said that in the NHS what gets measured gets done, but chasing the target, whatever it is, can mean missing the point. There is a genuine opportunity for change with backing from the very top. Let’s use it to make care a seamless experience for all, no matter what their condition or where they live.