Making integration happen
“Integration is going to be as important as competition”, health secretary Jeremy Hunt has declared.
It is a message ministers have sung ever since the word was crowbarred into the health reforms to calm fears over increased competition.
To date, very little has happened - apart from endless attempts to define the meaning of integration in the context of health and social care and a few brave attempts to drive change at a local level.
But now change is in the air. Poor integration between NHS services and with social care is perhaps the biggest cause of patient complaint. Mr Hunt says he wants quality of care to be as important of quality of treatment. Meanwhile, his Liberal Democrat junior Norman Lamb will be determined to ensure integration becomes more than a buzzword.
But there is another, complementary, plan doing the rounds in government circles. This involves a “whole city” pilot of full integration, with pooled budgets and all health and social care players expected to get involved. The lessons from this pilot would be used to guide the next round of service reform.
There is careful checking going on to make sure this approach is possible within the constraints of the new Health Act.
The current view is that it is, as long as the secondary legislation setting out Monitor’s obligations to ensure appropriate competition are drafted flexibly enough.
It will also be necessary to find an area where commissioners believe the pilot to be a good idea and to ensure the NHS Commissioning Board is bought into making it a success.
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Readers' comments (6)
Anonymous | 12-Oct-2012 7:47 am
pooled budget took place in Torbay about 10 years ago. It was great and now with all the changes the budgets have been separated and more red tape. Please look at the good work and get it right. When health and social care was one, it worked great. You always think of the person as a whole not that is health and that is social care. will government ever learn not to reinvent but to evolve?
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Anonymous | 12-Oct-2012 5:56 pm
Biggest cause of patient complaint is as it has been for the last 10 years: GPs not answering phones and making it difficult for patients to get appointments (ask Ben at Mori). Could be solved over night but those who run the NHS choose not too... dont hold your breath on nhs/social care integration
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Anonymous | 15-Oct-2012 8:55 pm
'Guide the next round of service reform'...you must be joking! This is getting like generals planning for World War 3 before World War 2 had started....let alone finish. In any case this obsession with every organisation getting bigger and more complex has to to stop.
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Anonymous | 16-Oct-2012 11:45 am
Government will never evolve, it will always reinvent, it's party politics and ideology. Labour threw out fundholding and then bought back watered down PBC. It's all spin. Trick is to hold tight to the principles (we're here for patients) and not get bogged down in the latest shiny new policy toy. Hard to do in such a turbulent environment!
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Patrick Newman | 16-Oct-2012 1:39 pm
Integration - holy grail and motherhood and apple pie combined. Competition by its very nature will militate against integration and optimisation of resources. Sharing/pooling budgets may have to result from integration but it should not be conflated with it. No surprise privatiser Hunt rates competition as important as integration. The battle lines are drawn.
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Anonymous | 24-Oct-2012 2:02 pm
(to paraphrase a previous article) Integration is brilliant and is certainly the only way we'll thrive from now on. But just using the word or the ideal and then doing the same old stuff won't achieve much.
Integration is just one coordinate in a landscape of care from a small isolated intervention at one end to a huge chaotic fabulous swarm of indivisible activity at the other. The main issue is context, as nothing is a panacea for all ills.
If I need a bit of physio for my elbow, then I don't want the entire behemoth to rise up with all it's bells and whistles. Leave me alone, I want a bit of physio or even just a quick chat with a physio-tech and preferably today.
Integration is only effective for people with 'complex needs' and this is a sorely misunderstood phrase. It doesn't mean complicated, or hard to do, or requiring sophisticated interventions, or whole system commissioned pathways.
Complex means that I have a number of related factors that affect my life and those factors and the relationships between them are sensitive to change over time.
So if my elbow is sore and I have heart disease and one leg and live on my own with no family or friends or money. You cannot predict what will happen in advance, you have to work with me over time and adapt your response to suit my changing needs. A more bendy elbow, by the way, means I can wipe my own bottom and stay clean and happy.
Take a deep breath! You won't see that with a mechanical secondary care style episodic referral and discharge bureaucracy between fragmented bits on a hierarchy diagram designed to do bums and elbows in different places.
The only place in reality that integration will ever exist is in the hands of the group of practitioners from different professions who are brought together to work with the person over time. Continuity of relationship!
The organisational mechanisms and strategies and tools and registers are all the same old fashioned industrial teleological controls dressed up as if they are something new.
Integration requires an in-depth real time understanding of the complexities of life, an inconvenient biological system that self-regulates through feedback. Complex systems cannot be invented or implemented or predicted, as they emerge in real time, in real work, in real life.
We are great at setting up fandango machines to rush out to people who have fallen off their bike and use amazing techniques and resources to patch them up and put them back on the same wobbly old bike. Sometimes the most complex person just needs a few minutes of someone holding the seat, so that they don't fall off. Simple and unsexy stuff.
Time to come out of the frenzied industrial dark ages and get back to focus on people who are good at helping other people. It's not hard, but you do have to unlearn 200 years of reinventing steam powered sledgehammers.
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