Health & care integration: The experience so far

Last week my colleagues and I attended the LGC & HSJ Integration Summit, a gathering of leaders and managers from local government and health to discuss ‘how to make the integration of health and care a reality’. Lots of experiences and stories of integration were shared, but some common themes emerged from the discussions:

• Leadership is key as the ‘belief’ to delivering effective integration

In IMPOWER’s workshop about half of the attendees had been through a form of integration, but none have had a positive experience of it working. Some felt that integration doesn’t save money but we cited cases of where it has been done well, there is evidence that it can drive much better outcomes at significantly lower costs. However, balancing the books alone through integration is not the way to inspire change amongst frontline staff (and in our presentation we stressed the importance of prioritising time up front to engage and inspire the key stakeholders). The Sustainability and Transformation Plans (STPs), which were submitted yesterday, will all have integration at their heart and will be important in both bringing key players together and developing an overarching aspiration for health in local areas. This will be key when it comes to engaging with Primary Care which is proving difficult for some.

• Frontline staff need the right tools and support

The core theme of IMPOWER’s presentation was that integration is an implementation challenge above all else, and it’s important to access the right skills and capacity to make it real. In one locality, it was discussed that substantial time is being spent on getting messages to frontline staff, with an emphasis on supporting people to become more independent. It was felt that some staff are ‘getting it’ but there needs to be ongoing support, not just a one off message. The right tools also need to be in place if staff are expected to have a ‘different kind of conversation’ with users and patients about their care. In terms of the integrated frontline workforce, more is needed to engage and convince. We discussed how behavioural insight techniques can work to deliver this (and how IMPOWER has used them to powerful effect).

• Integration is ultimately about the user experience

Integration is all about the means as well as the end; the user should have a seamless pathway of care where they only tell their story once. As a result, there needs to be more engagement with users and patients, as well as other key stakeholders to shape the process.

Overall, the discourse has definitely moved from talking about integration to actually doing it. But it’s obvious that it’s not been – or is going to be – an easy journey. As we often see in health, the focus tends to be on managing winter pressures. This in and of itself is not wrong, but that’s not the big win of integration. The real question is: How can we use integration to start managing demand as soon as possible to deliver change right across the next five years? It’ll be that question that not only addresses integration, but also how the NHS might meet its £30billion funding gap by 2020/21. The STPs are in and the clock is ticking!