19.11.14
Integrated care a slippery term
Everywhere you go in the NHS we hear conversations about the need for integrated and coordinated care, and it was the same at yesterday’s Foundation Trust Network.
No-one majorly argues against the concept of integration as, hopefully, the end result will lead to improved outcomes for patients receiving care closer to home rather than being reliant on long hospital stays.
But Nigel Edwards, chief executive at the Nuffield Trust, stated that “integrated care” is a slippery term, it is used but what does it mean?
He added that in some cases staff may say: “Our services are much more joined up, but the patients say we had 15 people visit us and we don’t know who is in charge. So the experience of the patient can be significantly different from the experience of the staff.”
Edwards, who has a strong interest in new models of service delivery and a practical focus on what is happening at the front line, stated that simply co-ordinating multi-disciplinary teams and some of the machinery of integration doesn’t necessarily catch it all.
“You can do quite a lot to integrate social care and community services with hospital care, but there comes a point where you have to have primary care in the party and that, at times, appears to have been hard,” he said. “There is international experience that proves it is hard as there is a significant cultural difference between primary care and hospitals. The evidence in the USA is that hospitals which try to integrate downwards tend to have higher costs than primary care that is trying to integrate upwards. This is because the hospital mentality, it is said, ‘infects’ the way that medicine is practised and care is organised.”
One thing we know for sure, from the conversations yesterday, the recent NHS England Five Year Forward View and all the political will, is that integrated care will be on the agenda for now and in the decades to come.
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