Integrated care for patients and populations: Improving outcomes by working together: A report to the Department of Health and the NHS Future Forum

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Integrated care is essential to meet the needs of the ageing population, transform the way that care is provided for people with long-term conditions and enable people with complex needs to live healthy, fulfilling, independent lives.

In its June 2011 summary report, the NHS Future Forum stated: 'we need to move beyond arguing for integration to making it happen'.

The NHS Future Forum's report built on the ideas that The King's Fund and the Nuffield Trust presented as part of the government's listening exercise on the Health and Social Care Bill.

In response, the Department of Health approached The King's Fund and Nuffield Trust for help in supporting the development of its national strategy on integrated care and to feed ideas directly into the ongoing work of the NHS Future Forum.

Our resulting report examines:

  • the case for integrated care
  • what current barriers to integrated care need to be overcome and how
  • what the Department of Health can do to provide a supporting framework to enable integrated care to flourish
  • options for practical and technical support to those implementing integrated care, including approaches to evaluating its impact.

The report asserts that developing integrated care should assume the same priority over the next decade as reducing waiting times had during the last.

Its core recommendations are:

  • government policy should be founded on a clear, ambitious and measurable goal to improve the experience of patients and service users and to be delivered by a defined date
  • patients with complex needs should be guaranteed an entitlement to an agreed care plan, a named case manager responsible for co-ordinating care, and access to telehealth and telecare and a personal health budget where appropriate
  • change must be implemented at scale and pace; this will require work across large populations, significant reform and flexibility to take forward different approaches.

The report makes a constructive contribution to the debate about integrated care and will be of interest to policy-makers, health and social care commissioners, and researchers with an interest in integrated care, as well as to health and social care organisations.

Comments

julia ross

Position
COO,
Organisation
Pi Benchmark
Comment date
05 January 2012
It was a real pleasure after so many years to read such a succinct and well worded report on how real integration can be achieved.. No change to structures being proposed is revolutionary and very welcome.

The changes will need a shared evidence base across the NHS and Local Government- mainly social care and this is already being quietly achieved in a number of areas. Innovative approaches are already being developed to sharing data together and this need not be time-consuming and expensive, as pilots on integrated data sharing and costed care pathways in Southend and SE Essex have shown. However, overcoming the muddle of thinking and many myths that have been perpetuated on this highly significant issue does need urgent attention from the DH . This will avoid as the report says, a considerable waste of taxpayers’ money.
It’s worth noting, however, that it is now perfectly possible and indeed relatively straightforward to undertake an assessment of the costs and activity of care services to support change and better outcomes for individuals

vinesh kumar

Position
Programme Manager, Integration,
Organisation
London Borough of Redbridge
Comment date
05 January 2012
Great report!

'it is a specific provider that is currently subject to regulation in respect of service quality, rather than services across a continuum, which is what patients, service users and carers experience' says it all...

your take on data sharing across health and social care, information governance warrants special mention.

Hope to see clear emphasis on Integrated Care in the Social Care White Paper this Spring.

Mike Nicholls

Organisation
Chair RESEC Cornwall
Comment date
07 January 2012
Clearly integrated care is a goal for which we all must strive.. As the two services merge it will become less clear what is Health and what is Social Care.

It will therefore become more difficult to assess charges for the Social Care part of the service. A totally seamless service will not be achieved until these matters are resolved.

Rapid progress is needed if a crisis in social care is to be avoided. After the White Paper in the spring the time for talking must end and adequate funding and action follow.
Mike Nicholls

Julie Pearce

Position
Chief Nurse, Director of Quality & Operations,
Organisation
East Kent Hospitals University NHS FT
Comment date
23 January 2012
Great report - well constructed and easy to read. I agree with the fundamental questions of integration and improving outcomes together - describing practical models that can deliver the above.

My question and comment is a slightly broader one - possibly a philosophical question, but one which we probably can't afford to shy away from?

The leadership challenge may also be about reducing future demand - what is the role and responsibility of individuals, families, and communities in reducing demand for services across the whole of the public sector (they are all interconnected). How do we begin to change the expectations, attitudes, behaviours, - what is our role in supporting this change as commissioners and providers of integrated services.

It is relatively straight forward to identify and describe structures, processes and outcomes, however, the human factors and the nature of rights, choices, responsibilities, behaviours are equally important and probably the most challenging as they fundamentally challenge the perception of 'citizens' about their relationship with the 'state' and 'public services'. Accountability may need to be described in a broader sense - accountability of each citizen to one another, their community, and shared responsibility for the effective use of public services.

Integration of services is a great start, and will not necessarily answer the whole question around future demand.

Richard Lohman

Position
Substance Misuse Worker,
Organisation
Oxford Health NHS Foundation Trust
Comment date
25 January 2012
I agree with the above comments, the time for talking about this has to transform into action. The Kings Fund is a well respected organisation and this report needs actioning within a given timeframe, it is for the DOH and LINks/HealthWatch to now take up the call and show/lead the way - guiding CCGs in their commissioning decision making

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