Understanding integration: how to listen to and learn from people and communities 

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The move towards integrated care has been the defining policy in health and care over the past decade and will continue to gather pace with the development of integrated care systems (ICSs). The aim of integrated care is to improve people’s outcomes and experiences of care by bringing services together around people and communities. This means addressing the fragmentation of services and lack of co-ordination that people often experience by providing person-centred, joined-up care.

One key question for ICSs and the partners working in them is how they will know whether they are meeting the needs of the people they serve. Those best placed to understand what they need, what is working and what could be improved are the people and communities using services. Their lived experience is a powerful tool to improve existing services and identify new and better ways to meet people’s needs.

Currently, people’s experiences of health and care services are usually collected and understood at the level of individual providers (Wellings 2019). This means we know about people’s experiences of individual services, such as general practice, hospitals or social care, but not about whether these services are working well together to meet people’s needs.

Over the past year, Picker and The King’s Fund have been working with NHS England and NHS Improvement on how ICSs can listen to and learn from people and communities. We have produced a practical guide for partners working in these systems, with ideas on how they might go about this. There is no one-size-fits-all solution. It will require a range of different methods and approaches to understand, monitor and measure how well people’s needs are being met. Perhaps most importantly, it will require partners to listen and learn together. As important as the methods adopted, will be the importance placed on this area of work and we have put together a set of principles for systems to adopt to ensure that the voices of people and communities are at the heart of partnership working. 

The guide, created by The King’s Fund and Picker on behalf of NHS England and NHS Improvement, has been developed with input from ICSs, patient leaders, and engagement and experience experts. We hope it will prove useful to systems and will encourage and help them as they work to co-ordinate services around what matters to people and communities.  

If you have any questions or would like further information about the guide or about understanding, monitoring, and measuring people’s experiences of integrated care, please get in touch.

NHS England and NHS Improvement provided funding and support during the creation of the guide.

Read the guide

This practical guide will help systems to co-ordinate services around what matters to people and communities.

Download the understanding integration guide


J Bhoot

Principal Business Analyst,
Comment date
31 August 2021

Very interesting article with similarities to the development of PHM systems which faces the same challenges as the development of ICS. The guide is certainly correct in saying there is no one-size-fits-all solution but hopefully the practical guide can help with partner working and encourage them to work together to co-ordinate services around what matters to people and communities.

Allan Kyte

Primary Carer and Government Lobbyist on Care,
Comment date
25 July 2021

Whilst the need for integration between sectors is vital in order to overcome the fact that quite often the right hand is not aware of what the left hand is doing, across Health and Social Care which ,apart from anything else exacerbates the serious bed blocking issue. My involvement however, centres upon an even more urgent need ,that being ,"the amount of appallingly poor quality care that is taking place within "social care", across the country and the inadequate level of monitoring and supervision ,both of which can and does, have some devastating affects upon those who are dependent upon it . I know ,because such issues are now often brought to my attention by friends and/ or relatives of those who experience it and even other care staff ,being aware of the fact
that I can and that I am quite happy, to point those affected either "in the right direction " or ,more often than not bring it to the attention of the of those who need to know , on their behalf, which I have now been doing for decades.
My wife meanwhile ,is a bed bound quadriplegic and I have been her Primary Carer for forty years and having struggled along alone for many of them , I set out to study the subject, in order to safeguard her well being, since when I have ensured that this is done to the required standards and know what to do ,if it fails to do so having been involved in the introduction of the "2014/15 Children and Families Act" and the "2014/15 New Care Act",
both of which sadly ,I consider ,has failed to achieve their full objectives!
Meanwhile, standards of care in this country have deteriorated dramatically, since it was cruelly taken out of the control Social Services (who were excellent) and farmed out to private enterprise by by Thatcher, since when the
quality has fallen like a stone ,which was both inevitable and predictable ,given the conflict of interests between
"Care Quality " and "Profit and Loss" and "there was only ever going to be ,one winner !
Since then ,a succession of governments (,including the present incumbents ) have turned their backs on social care and upon those who are dependent upon it ,for which, "THEY SHOULD HANG THEIR HEADS IN SHAME"!
Meanwhile ,the huge shortage of care staff grows ever wider ,as does the staff turnover within social care and this will continue to do so until "the terms and conditions of employment for care staff ,is substantially improved ,that
Social Care ,is recognised as "A Profession " (like nursing) with career opportunities as part of the package ,in order to create a situation whereby people "WILL WANT TO ENTER INTO CARE " and FEEL PROUD TO DO SO"
and to be able to move away from it's current image of ,"JUST BEING BOTTOM WIPERS "


Michael J Nort…

Public Governor,
Southern Health NHS Foundation Trust
Comment date
23 July 2021

Thank you for posting this comprehensive overview of this extremely important matter. This fundamental change which embraces the ongoing principles of improving how cost effective and professional care can, and must be delivered to the all important Service User has for me as a Elected Public Governor been of the utmost priority since my election.
I have always believed that the only way forward to achieve this and bring our highly valued and important NHS in line to cope with the 22st Century and the increasing demands placed upon it, is not to just keep on putting money into it when the system that it is being put into has so many inefficient working systems embedded within it.
The “Silo” system currently in place namely Primary/Secondary/Social Care has very little of what I have always called “Joined up thinking, and joined up working”,
so the Roll out of the ICS and the wind of change it brings is like a breath of fresh air which will I know when embedded enable our valued NHS, and its treasured and caring Staff to deliver a Heath Care Programme of Service which is commensurate with what out important Service User. rightly expects

Helen Clothier

Patient Representative,
I choose to support St Albans and Harpenden patient”s
Comment date
23 July 2021

Patients and staff should be treated equally and they are some of the time unfortunately not enough. When you see the elderly queuing outside GP practices in freezing weather due to the pandemic which new born taken straight in. What does that say about our society. The blame game is still strong with little understand of the complexities of humans. Bullying of hospital patients by senior nurses is a huge disappointment, I have suffered myself. I have call a hospital wanting to speak to the person in charge of type unit - I had no name the receptionist asked - do you want the fat white one or the black one. It feel as if we are in a children’s playground. Being involved with ICS I see a flourishing beginnings of commitment and collaboration.

Joanna Umo-Etuk

Hospital Consultant Anaesthetist,
Comment date
23 July 2021

Very informative information. Helps demystify NHS changes which the ordinary jobbing doctor misses out on while preoccupied with delivery of care.

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