Health and care integration – eating the elephant

It is well documented that demand for health and care services in the UK is continuing to rise year on year, with the majority of this demand being driven by an ageing population and an increasing number of people living with multiple long-term conditions.

The Care Quality Commission’s report ‘The state of health care and adult social care in England 2017/18’, published last month, builds on the Commission’s previous findings related to services for people with multiple or complex needs. It highlights how these services are not currently joined up around individual’s needs, in part because health and care providers are usually focused on their own corporate priorities and targets, rather than on working together to make sure people get the best care possible.

Funding, commissioning, regulation and performance management all conspire to encourage a focus on individual organisational performance, and unfortunately, it is clear that ineffective coordination of health and care services can lead to fragmented care for those who need it the most.

To have a sustainable health and care system that is fit for purpose, that is financially and operationally sustainable, that can meet increasing and increasingly complex demand, and is able to deliver the best quality of care possible at a local level, health and care providers need to come together strategically and operationally to provide person-centred care.

By working together to meet the needs of local populations, as well as jointly planning for things that impact on the demand for services (such as provider failure, bad weather, virus outbreaks and staff vacancies) it is possible to help people stay healthier at home for longer, and to better manage demand flows through the whole system.

Therefore, the measure of how effective and sustainable health and care services are is no longer just about whether individual organisations can deliver good care, but about the extent to which they can collaborate with other services as part of an effective local system.

To make that a reality, system leaders need to look beyond their own organisational problems. By widening the lens they may be able to identify opportunities to better manage demand through joint working, pooling resources and coordinating services locally. However, they need to be able to do this without having to jump through multiple hoops to get there, and the system therefore needs to be given more funding, commissioning and regulatory support to enable this to happen.

This might sound like an almighty elephant to eat – but as the saying goes, you need to take one bite at a time. What if there was a rich understanding of who was accessing health and social care services and what was happening to them? What if stories of service users were captured more frequently, shared at every meeting and were always a part of decision making? What if the sector started working differently with a small cohort of people and frontline staff?  This might just gather evidence for change and build momentum.