The integration of previously siloed services, not just in the healthcare sector, but across the wider public sector, is currently a core focus of NHS leaders. How this integration can be scaled nationally, whilst also retaining the local leadership and population-based approach offered by integrated systems, is a major challenge when seeking to establish partnerships between organisations.
This paper from the International Journal of Integrated Care looks at five factors that must be taken into account when considering the scale of integrated care; scale & volume, specialised knowledge, responsibility, local reasoning, and values.
The paper argues that to establish the most appropriate scale of integration, organisations need to consider; the target population; how the scale of integration will affect the professional diversity required to deliver a comprehensive service across all organisations; were the correct level of responsibility sits within organisations that don’t have the same governance or professional standards; the ability to develop relationships and trust among organisations to deliver coordinated services; and finally how the integration of services will be effected by the differing values and drivers among different groups at the varying levels of scale.
NHS Employers has developed a new toolkit for colleagues involved in leading and delivering international recruitment across the NHS. The toolkit encourages robust, efficient and ethical practices and processes for the recruitment of international staff across a wide range of professions and focuses on trust collaboration to scale up recruitment activity. The toolkit also contains examples of good practice, practical tips and checklists.
Public Health and Primary Care already share a number of functions in the delivery of services and management of population health; however, as Primary Care Networks expand and take a more holistic role in the management of population health, there may be increased desire for further integration between the two services.
This report from the WHO European Observatory on Health Systems and Policies (EOHSP) examines the basis for the integration of Public Health and Primary Care. It identifies the primary drivers of integration of the two services and the considerations and challenges that have to be overcome if integration is to be successful, including the risk of sharing already limited financial and human resources. The report also cites the possible benefits to be gained, including cross-sectoral training and education, and policy and programme development using a wider range of population data and stakeholder opinion.
The report is supplemented by brief case studies of successful integration across Europe and North America and identifies shared goals, community engagement, aligned leadership, sustainability, and the sharing and collaborative use of data as the core features and considerations of successful integration.
This report from WHO Europe examines the provision of integrated long-term care delivery in Denmark. Characterised by its universality and decentralisation, the delivery of long-term care in Denmark is based upon the principles of prevention and effective management of illness, and re-ablement services. Both are the result of a shift away from institutionalisation, which began in the 1970s, to a focus on independent living, which has resulted in two thirds of long-term care being delivered at home and in the community.
The core components of this integration are: a comprehensive package of services to all, with multiple points of access; multidisciplinary working, governance and regulation at the municipal level that is supported by national frameworks; professionalisation of the long-term care work force, and a high level of interoperability between organisational information systems.
However, despite performing better than the EU average, Denmark is still struggling with variations in health outcomes across socio-economic groups, as well as having to deal with the sustainability of the workforce long-term. Similar to the issues facing England, the Danish approach may offer opportunities and solutions to UK health and care organisations.
A study paper from the International Journal of Health Policy and Management examines the factors that support policy-makers in adopting a greater level of systems thinking when developing, implementing and evaluating policy designed to support preventative health.
Despite some confusion surrounding the concept of what systems thinking is and its function, the majority of policy-makers participating in the study were able to identify the positive implications of a systems approach to their work. Using research, tools, new ideas and resources they were able to gain a broader understanding of the challenges and influencing factors that need to be addressed when designing new policy.
Digital and AI
This report from the Organisation for Economic Development and Cooperation (OECD) examines the use of telemedicine across OECD countries to deliver health care in a wide range of specialties. A growing body of evidence suggests that care delivered via telemedicine can be both safe and effective, in some cases with better outcomes than conventional face-to-face care, and cost-effective. However, despite these benefits, telemedicine still represents a small fraction of all health care activity and spending.
Key barriers to wider use of telemedicine remain, with providers and patients facing regulatory uncertainty, patchy financing and reimbursement, and vague governance. Inequalities in health and digital literacy mean that patients who most stand to benefit are also often those that are least able to access and make use of telemedicine.
The report argues that telemedicine has the potential to improve effectiveness, efficiency and equity in health care, but can also introduce new risks, as well as amplifying existing inequalities. Policy-makers seeking to maximise the potential benefits and limit the possible risks of telemedicine services can:
- ensure that only telemedicine services that improve health care quality and provide clear benefits to patients are pursued, and that patient experiences are measured,
- facilitate the spread of local and emergent best practices, through a supportive policy environment and knowledge transfer and dissemination, and
- promote a transition to learning health care systems and a culture of continuous learning and improvement.
Workshop, Study Visits and Conferences
The European Health Management Association will be hosting an executive workshop on value-based primary care from 30-31 March 2020, in Brussels. The two-day event will discuss frameworks and actions for delivering health and care for a population of complex, frail, chronic patients.
The 5th International Conference on Healthcare Reform will be hosted in Sydney, Australia from the 25th – 27th March 2020. Featuring keynote speakers from the USA and UK, among others, the conference will cover the key themes of International innovation, value based healthcare, service integration, digital health, capacity building, change management and policy re-design.
The Economist Intelligence Unit have complied a comparative analysis of lung cancer policies across Europe. The report identifies the weaknesses within health systems and the opportunities for governments to build awareness, improve prevention, early diagnosis and prognosis, as well as the development of high quality treatment.
The analysis reports that despite improvements over the last 30 years, the UK still has the second highest incidence and prevalence of lung cancer per capita in Europe. This is the focus of ambitious strategic cancer policymaking in the UK; the analysis proposes that the UK could go further, for instance on access to rapid diagnostic tests and to reduce unmet need.
Digital and Technology
The Korean Triage and Acuity Scale (KTAS) was introduced for the first time in 2016. Similar to the 5-tier Manchester triage system used in the NHS, the KTAS has been the focus of much research into its effect on A&E performance since its implementation. This new paper, published in the International Journal of Quality Improvement in Healthcare, examines the association between hospital admission, length of stay (LOS) and inpatient mortality one year prior and one year after its implementation.
Evaluation found that there was a significant reduction in these measures after implementation of the KTAS and that these improvements are attributed to the more effective triage of patients.
Integrated Care and health inequalities
Like many European countries, Slovenia has seen a rise in health inequalities between the richest and poorest communities. To address this, they have fully integrated primary care and public health by establishing health promotion centres in all 61 primary health care centres in the country. This has enabled a multidisciplinary team of healthcare professionals to link with the various stakeholders in their communities. This coordinated community-based approach means that the wider determinants of health outside of the health system have been able to shape strategy so that they can more effectively respond to the specific priorities within each region. This approach is achieving a high rate of vaccination among children, a life expectancy above the EU average and a sustained fall in preventable mortality.
A paper published in the Journal of Integrated Care, discusses the opportunity for Value-based healthcare (VBHC) to develop within the wider move to the integration of services. VBHC is at the forefront of many health systems’ strategies around the world, as it address qualities in health and care that are currently lacking within many systems, such as health outcomes across the broadest spectrum of population health, not simply within the silos of primary, secondary and tertiary care.
The paper found that for organisations to develop the best understanding of the patient perspective, they need to listen to informal carers and wider stakeholders, as well as the patients themselves. The measures used to capture patient outcomes should include social and wellbeing outcomes, and should be developed and standardised at the national level in order to avoid disjointed development of value-based health care across regions and institutions that would undermine the benefits of more integrated systems.
In response to requests from a number of research ethics committees, this WHO publication on Ethical considerations for health policy and systems research was produced by the Alliance for Health Policy and Systems Research and the Global Health Ethics Unit. The publication aims to provide advice on the interpreting of existing research ethics' principles in the context of Health Policy and Systems research (HPSR).
Within healthcare, greater emphasis is now being placed on public health and social sciences and the contribution they make to equitable and effective health systems. Researchers in this relatively new field of research face the challenge of working in such a multidisciplinary field with its own set of ethical challenges.
During the transition to integrated care, and a shift from the competition to the collaboration model of care provision, collecting evidence at the national, system and institutional level about what does and doesn’t work, and importantly why, will be crucial to ensuring that any structural changes lead to sustainable improvements in population health.
The benefits of multidisciplinary ward rounds, comprising doctors, nurses, pharmacists, physiotherapists and other allied health professionals and the benefits that they deliver to patient care are becoming increasingly well recognised amongst health professionals, and were previously highlighted by the Royal College of Nursing, Royal College of Physicians, Royal Pharmaceutical Society and Chartered Society of Physiotherapists in a 2012 report.
New research by the Australian Institute of Health Service Management, the Australian Institute of Health Innovation and the Centre for Healthcare Studies at Northwestern University has added to this by identifying the key benefits and challenges experienced by health professionals involved in the ward round.
Holistic care planning, more patient-focused treatment and greater communication among professionals have been identified as the key benefits of the MDT ward round, but the time constraints of health professionals and the ability to coordinate such a diverse team remain major challenges that need to be mitigated through effective management to ensure that the benefits to patient care can be sustained.