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Integrated Care – the future

For many many years there has been a lot of emphasis on the importance of different health and welfare agencies working together. It is certainly now flavour of the month in the health and social care arena. It is all such common sense – how can it not be better both for the recipients of the services and for the holders of the public purse. It is all so obvious and simple so just do it! It may be obvious but if it was simple it would have been achieved a long time ago, and the acres of print devoted to the revelation that joint working is the way forward would no longer be being produced. In fact I think it is an immensely complex challenge and we serve no one well by not admitting that. Which is not to say that I do not agree with the current emphasis on integration in current government policy. It is in fact absolutely critical in order to make systems work for people in an age of austerity. It is just that time needs to be spent looking at why it has been such hard work to date.   As a contribution to that I make the following observations.

I suspect that too much emphasis is put on management and staffing structures. What really matters at heart is that people need to talk to each other in order to understand how they can complement each other in their day job and to share insights over individual cases. Co-location of staff rather than endless meetings is likely to achieve more.

The most important systemic change is possibly to have a clear and agreed system of ensuring that everyone whose need for help goes beyond a certain threshold have a care co-ordinator appointed whose job it is to ensure that other professionals involved talk to each other and an overview of needs is taken. Acting in this way should be seen as an extension of all key care agencies roles and the responsibility should be shared around. The skill involved in good care co-ordination should be recognised and built into each agencies core-training programme. Are GPs in the best position to play this role – the fact that they struggle at the moment to manage to take an overview of even their patient’s’ physical health suggests that they would need a lot of help to truly be able to.

Sharing of information and expertise is a really important part of developing new ways of working. A way needs to be found to help people navigate their way through the information explosion to find what they need to know about the enormous range of community resources that are there to help them do their job. At the same time sufficient understanding to know when the intervention of another specialist might be advantageous is also really important – and this needs to be reflected in the way that professionals “train” and “support” each other. This does not mean that specialisation is not important – it is and the benefits of focussing specialist care in limited centres of excellence appears to produce significant positive results. It is just that all health, care and housing staff have role to act as triage-nurses for each other and know what they should do when they identify a problem. A problem shared really is a problem halved.

Somehow the message needs to be communicated that shared working is not an additional obligation but a way of making life easier and doing a more effective job. This requires a long-term commitment to an intelligent communications strategy – it will not be a quick win.

Information systems are important – again not a quick win but a long-term commitment to making the systems compatible and talking through a common approach to assessment and case recording is required. The commitment to a Common Assessment Process” must be more intelligently – too often in the past proper analysis that identified overlaps and synergies in existing systems and the need for information has not been undertaken – and as a result single systems just mean far more complicate systems and therefore fall into disuse.

Partnership is the future – we just need to work at it and learn when it does not fall into place.

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