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Clinical and service integration

Over the past decade a number of health policies have sought to put the patient first and to improve health outcomes.

Choice and competition have been key elements of these policies, but the importance of integrated care was highlighted by Lord Darzi in the final report of the NHS Next Stage Review.

Does integration of care act as a barrier to choice and competition? This question has long been debated and highlights the complexities and nuances of the issue. The debate should be informed by evidence on the performance of integrated systems – and by greater clarity on the terminology used.

Clinical and system integration makes a significant contribution to that debate by:

  • describing integrated care and identifying the different forms it takes

  • exploring the different levels within the system at which it operates

  • setting out the evidence for the different systems.

Integration can take a variety of forms, involving either providers, or providers and commissioners, who work together to deliver better outcomes at a number of levels within the system. This report summarises relevant evidence about high-profile integrated systems in the United States, such as Kaiser Permanente and Geisinger Health System and outlines examples of integrated care in North America and Europe for particular groups, such as older people or patients with long-term conditions – for example, the integrated health and social care teams in Torbay. It also explores the range of approaches to improving co-ordination for individual patients and carers – for example, the Care Programme Approach in mental health.

The report focuses on examples that are most relevant to the NHS in England in the context of the coalition government's programme. We hope that it will help to inform the future direction of reform.