Clinical and service integration: The route to improved outcomes

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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.


Pearl Baker

Independent Mental Health Advocate & Advisor/Carer,
Comment date
11 December 2015
As a Carer and Independent Mental Health Advocate and Advisor you learn by experience. It is crucial to Carers and patient's that a multi disciplinary assessment is carried out. Carers are assessed for their needs, that an emergency contact number is given to the patient and their Carers. This is the first 'joined up' thinking, then thought must be given to what daytime activity the patients will be provided with, this is called rehabilitation. It may be any number of things, but vitally important to recovery, without any activities, or psychological intervention the patient is nearly always 'doomed' from the start, to a lifetime of 'nothing'.

GPs are vital in this exercise as they are the 'gatekeepers' to referrals to other essential services that maybe required at certain periods throughout the initial stages of diagnosis. Believe me I know from experience. The second time it occurs to another family member you are much more prepared and I am afraid (go it alone) as usually there is nothing out there, and GP are ill prepared to know what to do with their patients, other than the monitoring of medication usually prescribed in the first instance by a Psychiatrist.

My go 'it alone' has proved the best ever. It is important not to put too much pressure on the person, and never ask how they feel? especially if you are a Paranoid Schizophrenic, this 'fuels' their Paranoia, you will know if all is not well, (especially if they live with you).

It is important that they are given something to do of self worth, if you have a friend in Gardening the best activity ever, (No pressure) for even one day a week, you will see the improvement. Secondly work on the activities they loved during the formative years. Table Tennis in our case, find a friend who knows them well also interested in the same sport, encourage them to take part again. (Confidence is the problems) Now a first team player in two teams, and a County player for the 'veterans' yes it has taken a very long time, we look forward, to other important areas, they wash and launder their own cloths, play golf with your dad, and guess what! Not one Professional in sight only us 'experts by experience'.

Sadly I cannot report this for my other son, who has been left by the LA to 'rot', again I am on the case, a bit late, but better late than never.

I am not considered a Carer, but who cares! the 'allotment project' in the summer is great, and the 'cooking' once a week with his sister a trained teacher has proved a great success, which he takes part with his friend. the hygiene a particular problem is being tackled, can't touch the food until you have 'washed your hands'. The visit to the flat to clean (essential) is going very slowly, but 'stripping the bed' is a start, but very late in life.

GPs are discharging patients from 'Care Plans' despite their obvious need for on-going support and care. The CQC must do more to ensure the 'MONITORS' standards are met by the GP who hold a Licence from them? they must also ensure the United Nations Convention on the Rights of Persons with a Disabilities are adhered to, rather than list all the Articles in the Convention it is important that ALL are aware. the UK signed up to this Convention.

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