07 January 2012

Integrated Care: some clarity?

Over at the Nuffield Trust, Dr Judith Smith tries to get us enthused about Integrated Care. It would seem that Integrated Care is a good thing, particularly for vulnerable and frail patients in the NHS. In principle I am happy enough with that, and for certain definitions/specifications of "Integrated Care", I would be delighted to see a greater emphasis on this.

However, I see a problem. "Integrated Care" is far too easy to say. It trips off the tongue and sounds like it carries significant import. It sounds like something everyone should want, and, moreover, if you say that the NHS needs to implement Integrated Care, it implies that a/ this is a radically new idea, and b/ that it's not already being done.

Now, I accept that the care of many patients could do with being a LOT more joined up than it currently is, but we need to be clear about some things. Most doctors and other health professionals in the NHS are already aware of the need for a patient's overall care to be considered in the round. We already have very dedicated GPs and others who try to take an overview of the patient and the decisions that need to be made at certain points to help them navigate towards the best outcomes possible.

So Integrated Care is not a new idea - at best it is just a new label for  what we (largely) try to do already, and indeed is arguably a core principle of the National Health Service. It can be improved, and possibly it can be improved a lot. What is needed to achieve improvements in the integration and linkages of healthcare needs for individual patients (not as snappy a title, I'll grant you that, so from here on, if I use the term Integrated Care, that's what I mean) is not diktat that this radical new policy be implemented, but better targeting of resources to build on what is currently going on.

If one were cynical, one might think that this is a softener - a pre-emptive strike by the government to address one of the key objections to their ill-conceived Health Bill in England - that demoting health care services to "Any Qualified Provider" will inevitably lead to fragmentation and a loss of the Integrated Care that already exists structurally (if imperfectly) within the NHS. How better to grease  the pill than to pretend that the NHS is not doing Integrated Care, then put it (only as words, mind you) at the forefront of the proposals to destroy the NHS?

Making sure patients receive joined-up care is a well-duh. Let's not allow politicians to pretend that they've only just come up with the concept, and let's make the case for support for health professionals to continue to deliver an excellent service for the benefit of their patients.


  1. I agree.

    But making common sense things happen is sometimes difficult because of lots of silly historic reasons..

    So if we let the politicians think it's new and trendy, maybe we could help them set sensible targets or direct resources to relevant places? And use their energy and resources to make happen what we've been advocating all along....

    One of the problems though is that the please integrated care means different things to different people.... And in different parts of the country. It doesn't necessarily mean keeping some people out of hospital, which is not necessarily appropriate.

    It may be worth humouring (ie working with!) the politicians to get services more joined up. And if they take personal or party political credit for good things happen, well so what.... If things improved, then it may have been worth swallowing our indignation!

  2. I'm with Shane on this one too!