Integrated care: "Care has to change, because we are changing"
It’s fair to say that – in certain quarters – the Government’s attempts to implement integrated care at scale have been greeted with a degree of cynicism. The Better Care Fund (BCF), the pooled budget of £3.8 billion to further the integration agenda, was announced to very mixed reactions in June of last year. Some understandably raised concerns about where the money was to be pooled from; others were doubtful as to how feasible the implementation of plans for joining up services would be in practice.
The truth is that, while there are several successful localised initiatives which co-ordinate care around a person, making the transition to integrated care at scale is a difficult and daunting task. The complexity is real, the budget is limited and it’s not going to be completely smooth sailing throughout. But does that mean we should bury our heads in the sand and not tackle it at all? Of course not.
The needs of today’s population – and in particular those of the elderly demographic which makes up a large portion of it – are not the same today as they were when the NHS was first created. What’s more, the needs of the next generation of pensioners will be different again, as will our own needs when we ourselves are elderly. Put simply, services have got to adapt to meet this change. They cannot continue to help only one aspect of a service-user, in isolation of that person’s other wellbeing requirements. Given our increasing life expectancy, these other requirements will frequently involve care for multiple medical and long-term conditions – for example, if an older person is living with both diabetes and rheumatoid arthritis. However, a person’s needs will, in reality, extend further than medical care to encompass mental health support, mobility support, and additional social requirements, such as suitable housing.
Clearly, the role of local authorities is vital in addressing and coordinating these multiple needs. However, we need to go beyond seeing coordinated care as solely a local authority ‘project.’ Cooperation and compromise will be needed from both national and local services if integrated care is to work, as further fragmentation will only impede the potential for positive change.
It was with these things in mind that the LGA, NHS Confederation and our Integrating Care team at PPL organised a roundtable at the end of January – with the deadline for the first BCF submission looming – to tackle the issue of service integration head-on. The immediacy of hearing from so many strategic health and social care leaders, in the midst of grappling with the integration challenge, was invaluable as we look to help ease the process moving forwards. The various speakers were by no means all of one accord, but they did agree on two things: firstly that great work is already happening in several localities, such as Torbay, the Isle of Wight, and North West London. Secondly, they agreed that we will not get anywhere if we don’t start seeing those that use health, social and voluntary services holistically.
These beliefs certainly chime with our own experience. The challenges ahead in making integration work at scale are not insignificant, but the Better Care Fund has to be a first step in tackling them. The most important step, however, will not come in the shape of service reconfiguration, but in behavioural change and compromise, and an empowering focus on delivering the right outcomes for patients, carers and service-users alike.
Claire Kennedy is co-founder and managing director at PPL and senior adviser at Integrating Care
This article first appearead on the Municipal Journal website: