Last year, when the NHS Confederation asked you, its members, what major changes were required to meet future challenges, the vast majority of you (77 per cent) cited the integration of care – more than any other change.
With rapidly decreasing budgets, local authorities and health and wellbeing boards too are acutely aware of the need to bring services together more coherently.
Patients and service users will welcome this drive. “Integration, integration, integration” was the top demand of National Voices members when we voiced our views on Lansley’s reforms to the NHS Future Forum in 2011.
Yet, although veterans note wearily that efforts have been made to join up care over the decades, the track record so far is not one of notable successes.
Why should this be? One key reason is that once organisations start talking to each other about closer working, they begin to focus on their own processes and priorities, rather than making the benefits to service users the key yardstick.
And these conversations are bedevilled by different organisational perspectives on what ‘integration’ actually means, to the extent that one literature review found 175 competing definitions.
This context led The King’s Fund and Nuffield Trust to make two high level recommendations when they advised the NHS Future Forum and Department of Health on strategies to deliver integration.
First, that ‘the most fundamental prerequisite to the development of integrated care at scale is the crafting of a powerful narrative’ – a story that we can all share, about where we are aiming to go.
Second, that ‘the patient perspective’ should be ‘the organising principle’ for integration.
In this narrative, we no longer talk about ‘integration’ – it is not meaningful to patients. We redefine it as ‘patient centred coordinated care’, where the statement below is every service users’ realisation of care;
“My care is planned with people who work together to understand me and my carer(s), put me in control, coordinate and deliver services to achieve my best outcomes.”
What patients want, as our bespoke paper for the Future Forum noted, is for their care to be joined up. Whether the service organisations are actually joined up is secondary.
The narrative outlines a set of statements service users would be able to make if their treatment was well coordinated:
“I was always kept informed of what the next steps would be.”
“I always knew who was the main person in charge of my care.”
“That person helped me to get other services and help, and to put everything together.”
We suggest that if NHS commissioners and providers are able to adopt and work with these definitions and statements, it may help in making business cases and creating strategies and plans that are centred on benefits to patients, rather than about organisational process.
We include a statement of what this would all mean for an organisation that adopted such goals, aims and benchmarks:
‘partnering the person to plan, pick and pull together care, support and treatment’.
We are confident that this outline narrative works from the service user’s point of view. But does it work for you? As we refine and complete it for adoption by the NHSCB and, we hope, many system stakeholders, only you can tell us whether it adds value to your sense of what ‘integration’ should be about.
So please, as the new NHS system takes shape, take some time to have a close look at the narrative and share it with colleagues and partner agencies. Knock it about, turn it around and above all, give us your feedback.
Don Redding is director of policy for National Voices, the leading coalition of health and social care charities in England working to strengthen the voice of patients, service users and carers.