3 minute read
Integrated care – a new reality?
Putting patients at the heart of the system is the way forward, says Carly Caton, Partner at Bevan Brittan LLP
Here in England our health system is currently undergoing (another) transformation and reorganisation. We are awaiting the passing of the Health and
Care Bill, which is currently at committee stage in the House of Lords. Integrated
Care Boards were meant to be up and running and take legal e ect by 1
April 2022, but this date has just been postponed by 3 months to 1 July 2022.
The driver behind these proposed changes is to achieve a more integrated health system, putting patients at the heart of the system and achieving a joined up care pathway where all parts of the system are working in partnership with the same end goals. This is a concept that has been around for a long time and almost everyone, across political parties, seems to agree it is a good idea. While there are pockets of good practice in England, this has never been achieved at a grand scale – but there has never been legislation behind it before. Will it work now and what are the factors needed for true integration?
What would great integrated care look like?
• The bringing together of data and information from health, social care and other support organisations in relation to care delivery, care outcomes and workforce wellbeing and satisfaction.
• A people / patient centred health system.
• People working together to understand a patient / service user, their needs, putting them in control and coordinating services for the best outcomes.
• All of the above?
When I looked for definitions or explanations of ‘integrated care’ I was met with scores of di erent ways of explaining
it. That is because there is no ‘right’ answer and individual parts of the health system view this in their own way. A patient receiving care or services would see this di erently from a health provider or a commissioner of health services. Everyone is looking through a di erent lens.
Some countries are held up as demonstrating good examples of integrated care. For example, the Kings Fund carried out a study several years ago entitled ‘Providing integrated care for older people with complex needs: Lessons from seven international case studies’. The document compared lessons from seven di erent countries - Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the US.
Carly Caton Partner Bevan Brittan LLP
Key findings from the report showed that:
• Putting in place an integrated care system is a process that must be led, managed and nurtured over time.
• There is no single organisational model or approach that best works. The starting point must be improving care for people and not pre-determined. • Success is more likely where there is a specific focus on working with individuals and informal carers to support self-management.
The COVID-19 factor
Solutions that work in one country may well not do so in another country. Lessons can be learned from examples and good practice, but people’s health is influenced by so much more than the health system they happen to live under, such as their environment. A report written by Katharina Viktoria Stein entitled ‘Integrated Care around the world. Examples to help improve (primary) health care in Poland’ surmised that ‘health is not by any means only achieved in and influenced by the health system’.
In fact, it was suggested that the health system itself only accounts for about 10 per cent of a person’s health status with social and lifestyle determinants such as smoking, obesity, stress, nutrition, blood pressure, alcohol or drug use accounting for 51 per cent, with the environment accounting for 19 per cent and human biology accounting for 20 per cent of a person’s health. This underlines the importance of the prevention and education agenda starkly, because if you buy this concept then the health system alone can never make wholescale change on its own.
And what about the influence of COVID-19 and the fact that health systems around the globe have been thrown into disarray over the past two years? Many would say that this has in fact assisted with the integration of care. We have become better at finding di erent ways of doing things, making things happen quickly, cutting down organisational silos and boundaries which previously existed. Now it just remains to be seen whether this will be the decade when integrated care becomes a reality, rather than a much talked-about goal.
Contact Information
carly.caton@bevanbrittan.com
