Integration between health and social care remains an elusive goal but the essential building blocks are well documented, writes Paul Burstow

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“I’ll know when you’re all working together well when you sit on a platform together and I don’t know who is who.” : Quote from a person who uses services

Achieving integration between health and social care sometime feels like the quest for the Holy Grail. Only the most virtuous ever achieve the state of grace required for the mystery to be revealed.

Not clearly defined

Of course there are reasons why integration remains an elusive goal. It is not always clearly defined. The legal and accountability frameworks governing health and care are poorly aligned. There are tensions at the interface between a “free” NHS and means-tested social care. NHS Continuing Health Care often becoming a flash point along the border.

But this is the language and thinking of systems.

Lets look at it through the eyes of those who use services. This is what one said at a recent Social Care Institute for Excellence roundtable: “I’m not interested in the size of your budgets or the number of your staff – and how many buildings you manage. What I want from leaders is seeing people making good things happen and stopping bad things from happening.”

In other words let’s focus on the outcomes.

I’m not interested in the size of your budgets or the number of your staff – and how many buildings you manage. What I want from leaders is seeing people making good things happen and stopping bad things from happening

We have a working definition. Back in 2012, NHS England commissioned National Voices to co-develop a definition of integration. It took as its starting point what matters most to patients and people who use services. In 2013, after an extensive process of co-production, a valuable narrative emerged that framed integration from the perspective of the patient or person who uses services.

It summed up person centred coordinated care with this “I” statement: “I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.”

What matters now is the how this definition changes the DNA of organisations so that it becomes the new default behaviour. That has been at the heart of much work by the SCIE over the past few years.

SCIE was commissioned by the Department of Health in 2016 to conduct research with stakeholders and people who use services to test out an “integration standard”. A year later the Department published its Integration Better Care Fund Framework alongside SCIE’s research. The framework included the ambition of developing a wider integration scorecard to help areas assess their progress.

Good performance

We may have an agreed definition but we still lack a shared understanding of what the markers of good performance on integration are. How do we make integration more than a tick box exercise?

Rather than framing integration as a standard with a set of objectives, SCIE decided to develop a picture of how it is supposed to work and assess the “if-then” relationships between different enablers, interventions and personal and system outcomes of integration. Known as a logic model its purpose is to articulate what good integration looks like.

SCIE decided to develop a picture of how it is supposed to work and assess the “if-then” relationships between different enablers, interventions and personal and system outcomes of integration

The draft logic model is based on extensive consultation, learning from the vanguards, Integrated Personal Commissioning, Integration Pioneers and research. The project continues but it is informing SCIE’s work for the Better Care Support Team.

In the meantime over the next few months the Care Quality Commission will be reporting on what it has found from a series of up to 20 local system reviews. These reviews are seeking to understand why there is so much variation in how effective local health and care systems are at working together to ensure people get the right care at the right time in the right place.

At the local system summits at the end of these reviews SCIE will be on hand to help broker the help needed to support areas respond to the CQC’s findings and recommendations. Watch this space.

Integration remains an elusive goal for many places, but no one should be in any doubt that the essential building blocks are well documented. The missing ingredients are the voice of patients, a shared purpose and the patience to see it through.