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gp practiceJune 22 2016

A report describing how a fully integrated health and care system could come together to realistically meet public needs has been published.

The outline of the ‘whole-system’ vision is “based on forming care around the needs of individuals in a society with increasingly chronic and complex health needs.” The report also identifies challenges such as unprecedented pressures on funding which has put plans to improve patient care and the sustainability of the whole health and social care sector at risk.

Among the requirements needed to integrate health and care services more effectively, the report calls for:

• national leaders to re-dress the shortfall in funding, particularly in public health and community services as demand outstrips resource
• a cultural shift away from focusing on services only when people are ill or have critical social care needs, to improving public health and meeting the needs of people
• local leaders to look beyond individual organisations to work together to better integrate and make transformation happen quicker
• agreement and action to address the barriers to making integration happen.

The report, ‘Stepping up to the place: The key to successful health and care integration’, has been published by the NHS Confederation, Local Government Association, Association of Directors of Adult Social Services (ADASS) and NHS Clinical Commissioners. They are calling for a ‘gear change’ in approaching the issue, saying: “The status quo is no longer an option, and everyone must innovate and transform on a scale and at a pace not yet seen.

“Integration is not an answer in itself, or a panacea for the system’s financial challenges. Its primary purpose is to shift the focus of health and care services to improving public health and meeting the holistic needs of individuals, of drawing together all services across a ‘place’ for greatest benefit, and of investing in services which maximise wellbeing throughout life.”

The report notes that “many localities have developed integrated community health and care teams, usually around GPs or neighbourhoods. Similarly many are integrating around pathways.” The vanguard programme has been testing different forms of care, including joining acute provision with primary care, and bringing all out-of-hospital provision together around GP practices.

It calls for:

• local systems to embed integration as ‘business as usual’;
• a collective approach to achieving integration by 2020;
• consensus and action on the barriers to making integration happen;
• dialogue with national policy makers on ensuring integration is effective;
• ongoing testing and evaluation to develop the evidence base;
• national partner action to enable the minimum requirements to integrate effectively.

NHS Confederation Chairman Stephen Dorrell said: “The NHS continues to face unprecedented demand and challenging financial circumstances. Against this background, we need to make sure we are utilising all the collective resources of a ‘place’ to benefit our local communities. There is now a real urgency to deliver on this ambition. Our priority now must be to turn rhetoric into action.”

Don Redding, Director of Policy at National Voices, the coalition of health and care charities, has commended the “joined-up vision” for health and social care integration. “We are in agreement with the authors that services must be designed around the individual. People should be involved in decisions at every level, from agreeing the care and support they need, to co-designing services that meet the community’s needs,” he said.

He noted that the report calls for a single national outcomes framework for health, public health and social care, but with local leaders able to determine local priorities. “That framework should not be solely focused on clinical outcomes, but instead should be built on wellbeing outcomes such as independence, connectivity, and avoiding loneliness,” he said. “This report represents a welcome move away from ‘what is the matter with you?’ towards ‘what matters to you?’.”

Links:

NHS Confederation announcement

‘Stepping up to the place: The key to successful health and care integration’ report

National Voices comment

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