Do we really want ‘integration’ in a post-COVID world?
In last month’s CMM, John Kennedy asked, do we really want integration? His point was not that services shouldn’t work together, but that we might be approaching this wrong.
The idea behind integration is to enable both the health and social care sectors to work seamlessly together. This should support better pathways for people engaging with services, more shared information between health and care, and ultimately improved outcomes for everyone.
The initial issues
In principle, it seems like a good idea, but it has brought about challenges when being put into practice. The NHS Five Year Forward View, published in 2014, set out the importance of bringing the sectors together, giving examples of work already happening in hospitals and care homes that was improving experiences of care and removing burden from both services.
However, as early as 2016, Tom Buckley wrote for The King’s Fund that, ‘Pressures on health and social care have been growing year on year, with most providers now in deficit and key patient care targets being consistently missed,’ adding, ‘The main challenge of implementing the Forward View is to balance the urgent need for change with the pace of implementation.’
The more recent NHS Long Term Plan again mentioned the need for a more joined-up approach – although many at the time felt that this was a missed opportunity to create a joint plan for the future, as was the case for the NHS People Plan, which again deepened the trench between the two sectors.
Progress is being made
In spite of the difficulties, new systems and models have emerged that continue to make a difference.
We have seen the advent of sustainability and transformation partnerships (STPs), which were intended to bring together various services to share resource and ideas, and integrated care systems (ICSs), which see leaders take collective responsibility to improve the health and wellbeing outcomes and systems for the local community.
Care providers now have access to NHSmail and large NHS organisations are beginning to raise their voices to say that social care must be prioritised.
How has COVID-19 changed things?
While progress has been happening, it has historically been extremely slow. Information sharing and equal respect have been difficult to establish, but the COVID-19 pandemic forced things to change rapidly.
Suddenly, hospitals were forced to share patient information with care providers, and care providers had to work with local health services to protect the people who used their services.
However, the change has made people question what we are doing to ‘integrate’ health and social care. More and more are agreeing with John, that we are approaching it from the wrong angle and that actually things could be much simpler. Our experts share their thoughts.