The Health for Care coalition of 15 health organisations, led by the NHS Confederations, argues that any new social care settlement should reflect the principle that care and support needs to be integrated around the needs of those using the service, their families and carers. Nav Chana, national PCH clinical director of the National Association of Primary Care, writes that the concept of integrated care is not a new one.
Integration is one of those concepts that appears in the ‘word salad’ of phrases that permeate strategy documents in many organisations at the moment. Most recently, the language of integration is peppered throughout the NHS Long Term Plan.
Implementing integrated care, however, remains elusive - partly because of the various typologies of integrated care that exist: vertical, horizontal, organisational, clinical, etc. It’s sometimes hard to know where to start!
My preference is to consider integration from the perspective of patients for whom care integration is imperative; patients for whom integration should be at the heart of care delivery.
The NHS Confederation highlights nine key principles for a new social care settlement, and integrated care is the first one of these. However, it’s important to remember that integrated care is not in itself an end, but a means to improving outcomes for those with increasingly complex care needs in our communities, and in turn a means to improving population health.
We all understand the impact of the ‘broader’ determinants of health, for example housing, employment, isolation, education on enhancing people’s health and integration works best when many agencies come together – focussing on achieving what matters to patients through personalisation of care, as well as improving health for the wider population.
This has been a hard lesson for me to learn after a quarter of a century as a GP in East Merton, where health inequalities between the most deprived and least deprived of Merton seem to have widened.
There is of course a close relationship between personalised care and population healthcare – personalised care empowers the person and offers greater ‘precision’ of care delivery which can lead to more resources available to benefit the wider population.
Key to everything is a workforce built for integration that is built around the care functions and skills needed to care for people with complex needs.
Simply focusing on workforce numbers is not enough – we need to think much more about the key ingredient of team-based care, where teams are drawn together from various providers - NHS, social care, housing, voluntary sector - but those teams are built around the needs of people.
The National Association of Primary Care (NAPC) through its primary care home (PCH) programme, with 229 sites serving ten million people, 17 per cent of England’s population, has developed a model for delivering integrated care around defined populations of 30,000-50,000 people.
This has informed the policy for primary care networks as described in the NHS Long Term Plan. There is much to learn from PCH colleagues around the country who are successfully embedding integrated care approaches.
It’s no surprise that a collaborative leadership approach is vital for success for this integration - built on strong relationships - to improve the lives of those who need our care most and ultimately for the health of the population overall.
Dr Nav Chana is a GP and national PCH clinical director of the National Association of Primary Care (NAPC). Follow the organisation on Twitter @NAPC_NHS.
This blog is part of a series supporting the Health for Care campaign. Read more in the series here.