Why is integration so important?

Dr Robert Varnam, who is jointly leading the NHS Future Forum’s work on integrated services, asks why this is such an important issue for health and social care.

It’s a great honour to be embarking on this new phase of work at the Future Forum.  There’s certainly no lack of interest in integration at the moment, and I believe it’s a pivotal issue in our endeavours to improve the health of the nation.

So why is integration such an important issue for health and social care?

A railwayman once explained to me that ‘the real skill’ in creating a safe and smooth ride was not in the tracks themselves.  Making smooth tracks was easy, he explained.  No, the difference between a good and a bad ride lay in the quality of the welding.  The joins between the tracks accounted for most of the bumps (or lack of them) and it was at joints or points that most trains derailed.

As with many things, we in healthcare are just beginning to learn from the design principles others have used for decades.

Our health and social care system is a huge and complex beast.  The NHS alone is the third largest employer in the world.  Much of the time, our attention has been focussed on the individual building blocks of this system – the wards, teams or processes in a hospital, for example.  While it’s clearly essential for these to be as good as they can be, patient care is influenced at least as much by the way in which the individual building blocks are put together.  Great blocks assembled in a disorganised way don’t make a great building.

As a GP, I also know that it’s hard to be great individually if the system around you doesn’t join up properly.  So a failure to attend to integration produces the worst of both worlds – frustration for staff and poorer outcomes for patients.

Integration has become more important as we’ve acknowledged the very different challenges posed by growing numbers of people with complex long-term conditions.  Whether serving a person with diabetes or dementia, we must think not in terms of appointments or services but of journeys or pathways.

Problems of misaligned services aren’t the most glamorous but they may be the most numerous.  But it’s only when every element of care is aligned properly and joined tightly that the patient journey will get smoother and we can spend less time picking up the pieces after a derailment.

The Future Forum is about listening.  We’re serious about not pre-judging an issue, imposing a particular ideology or making assumptions about an agenda.  Put simply, we want to hear your answers to the big questions about improving integration.  What works?  What doesn’t?  How do we overcome the very real barriers to creating more cohesive patient journeys?  How can teams from local authorities and the NHS work together more seamlessly?

This is a great opportunity for all of us in health and social care to make things better.  Please help us by getting in touch and taking part in our conversations.

In Conversations, NHS Future Forum, Robert Varnam | Tagged

2 Responses to Why is integration so important?

  1. Rod Whiteley says:

    There is a danger that thinking in terms of journeys or pathways only extends the old notion of process targets to more grandiose centrally-planned processes. I think we need to focus instead on individual patient outcomes. Certainly, for planning purposes, railway journeys are a useful analogy, but individual patients need flexible tickets that allow them to exercise choice over route and destination.

    To say that every element of care must be aligned properly and joined tightly is to pre-judge the issue, unfortunately. A better model might well be elements that are loosely coupled and independently fault-tolerant, a bit like railway carriages.

  2. Jennifer Bernard says:

    Could we please start by realising that in social care we are people and not patients, with a whole life and not only a need for health care. Taking a patient journey perspective is only part of the potential solution and must not derail social care from taking a much wider individual/family/community/society perspective.

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