3. Ensuring services are better integrated around people’s needs

People’s lives rarely fit into neat compartments. Getting the care we need may involve several different services and agencies. We want to discuss how local services can work better together to meet people’s needs. Read more about integration…

What do you think?

a. What does ‘good’ look like? Where are there good practice-based examples of integrated services that support and enable better outcomes?
b. Where should services be better integrated around patients, service users and carers – both within the NHS, and between the NHS and local government services, in particular social care (for example, better management of long term conditions, better care of older people, more effective handover of a person’s care from one part of the system to another, etc)?
c. How can integrated services achieve better health, better care and better value for money?
d. What, if any, barriers to integration should be removed, and how can we incentivise better integration of services at all levels?
e. Who needs to do what next to enable integration to be progressed in a pragmatic and achievable way?
f. How can innovation in integrated care be identified and nurtured?

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12 Responses to 3. Ensuring services are better integrated around people’s needs

  1. claire rhodes says:

    I work for a joint funded health and social care team in Nottingham. We have been providing an ‘integrated’ service for many years but this is now threatened by local council cuts (they cannot afford to fund our Social Workers and Community Care Officers anymore and are pulling them out of our teams). This will only cost more money in the long run as hospitals and other health services will be clogged up with people awaiting social care because there aren’t sufficent social care staff to commission care packages etc. If you’re really committed to integrated services then you have to fork out for them.

  2. Jayne pye says:

    First immediate comment regarding other matters relating to ‘caring for our future’ why have you not included inormation regarding LTC development programme? One would logically think departments do speak to each other and this programme will have far reaching holistic outcomes, if taken on, for many . Integration is the key to wellbeing and budgeting .

  3. Tam Harrison says:

    We have been working towards closer working relationships across differnet health and care professionals for years, but it is slow and affected by various restructurings in the differnet organisations. There still seems to be a lot of reliance on the quality of the working relationships betwen individual staff and this breaks down when particular people move on. Different funding streams and eligibility criteria means that integration can break down when one service changes the funding or eligibility. If teams are integrated then the funding needs to be integrated or merged too.

  4. Tom Cooper says:

    The best way to provide greater integration would be to put more money into the health and social care system, which is clearly not going to happen any time soon while the country’s debt crisis grows ever deeper. It is natural for practitioners in each separate section of the care system to protect their own budgets and allocate resources that suit their priorities and that can never be fully overcome. Whether we like it or not individuals will continue to have to fit into the system, however it is restructured, because there is in reality no way to engineer a truly flexible model and I wish politicians and planners would recognise this instead of making undeliverable promises.

    Despite these limitations, with adequate funding there would of course be more options available and the practical effect would be to enable people in need to access services more tailored to their particular circumstances. At the end of the day a lot of this will depend on how good Andrew Lansley and Paul Burstow are at persuading the Treasury to allocate the funds. May I suggest that fewer expensive foreign escapades for our armed forces would help?

  5. Mike Bracken says:

    My experience in Solihull is there are many groups offering varying levels of support but they are not adequately networked with each other of with those requiring support. Finding the right support group is moreso by luck than by design. To resolve this requires investment in social networking media and outreach workers to find those requiring support and ensure the support matches the needs.

    I have also found in my case the fathers support group I attended (the only one in the area) had its funding cut and is no longer finding fathers of children with special needs through outreach workers. There is also a cut to the support staff attending the group. While the group had adequate funding it was well attended and staffed. Now the funding has been cut fathers can not afford to self-finance it. This has led to the group falling apart.

    In conclusion, I would say groups should communicate better with each other and with those in need, but should also be adequately funded or we are fighting a losing battle.

  6. Andrew Irvine says:

    Integration of Social Care and Health Care is a must. Staff working together around local needs of patients ensuring the GP is the clinical co-ordinator of care. Local teams need to be responsible for the local population they are service, whether a patient is at home, in the hospital, in a care home etc. Places of care are irrelevant and organisational boundaries need to be reduced and replaced with pathways of care.

  7. Varsha Dodhia says:

    Integrated Care is a question of coordination and ensuring is that Right Care at Right Time in Right Setting will actually deliver Right outcomes and eventually cost less. As all commentators say Health and Social Care need a combined approach and not turf wars or finger pointing. So much duplication in multiple assessments, management bureaucracy and multiple gates to go through makes those who need care and their Carers struggle to navigate the system.

    We have a very inefficient system where someone occupies a hospital bed waiting for discharge but as the Social Care team struggle to find a place. The hospital bed costs far more.

    We have a situation where Mental Health Services are invsentivised by responding to crisis and not intervention at an earlier stage when recovery has a shorter course to take.

    As a system we fund a patchwork of services delivered at different quality and less regulation than before of the critical ones. CQC by following self assessment has really taken their eyes off the ball and are now under performing their Quality Assurance Role.

    Healthwatch is being proposed but if we need a local organisation, it needs to be properly resourced. LINks have done some good work but are not very effective.

    Integration is everybody’s business if we are to ensure that Quality outcomes are achievable at a time of financial difficulties not no more new money in the system in the foreseeable future.

  8. Bridget says:

    In Herefordshire there is an admirable aspiration to have multi-disciplinary teams at work in localities so that individuals only have to tell their story once in order to be assessed for service eligibility. The NHS and adult social care providers are now one organisation (apart from mental health). Sounds good and maybe it will be. Integration makes sense. But only if it is done properly. There will still be need for specialists, and for better advocacy and signposting – like PALS, which has become a well-known and effective route for baffled and discontented citizens.

  9. Jan says:

    As a manager for integrated services for many years the problems and solutions have remained unresolved. Firstly, health and social care need alignment of pay and conditions, secondly resources and staff need to be pooled and co-located to find common solutions/experiences. Thirdly, technology is needed which prevents duplication and a joint care plan/history of the client.
    Lean thinking and duplication is impossible whilst we continue to generate information independently of each other and repitition for the client. I could go on and on but in essence these are the priorities.

  10. Marie Vistartas says:

    There needs to be more support with regard to decent safe stable wheelchairs and house adaptions for everyone. For example if a couple work they are refused funding for wheelchairs and house adaptions and it isn’t right and it isnt fair. Dan and I have worked since we were both out of education but just because we work it doesn’t mean we can afford a powerchair at say 7k and housing adaptions (whatever cost that may be!) We have a mortgage to pay, council tax, bills, food, petrol for two cars.

    Dan also has to pay for any repairs, tyres on his own car because obviously his car isn’t motability. They need to provide every disabled person with wheelchair funding and house adaptions because even though people work it doesn’t mean they have extra money for disability things. We are just trying to get by like any other couple. This all needs to change.

  11. Natasha Muirhead says:

    3) Shaping local care services
    How can we make sure there are lots of local organisations, which can provide different types of care?
    This can be achieved by making sure that there is good communication between all parties concerned with an individual’s health, including those professionals who provide primary care services such as GPs, dentists, opticians and NHS direct. When I recently changed dentists it was only because I told them and provided them with some written information from Autism West Midlands on Asperger’s Syndrome that they then knew I had a disability at all. I do very strongly believe that it should not just be the individual’s responsibility to tell other relevant health and social care organisations that they have Aspergers Syndrome. It should be made compulsory that every health and social care organisation knows how to recognise autism and they should receive information about it so that they are better equipped at knowing how to treat someone with autism. I found on a routine check up with my dentist that I needed to have some of my wisdom teeth removed. The dentist who by then knew that I had Asperger’s Syndrome referred me to my local ENT (Ear, Nose and Throat) department so that I could have this procedure done but again it seemed to be left solely to my family and me to inform my local hospital department that I had Asperger’s Syndrome. Good communication really is essential between different health and social care organisations so that they know well in advance that a patient with Asperger’s Syndrome has been referred to them, how to treat them in the most appropriate way and that everyone is different.

  12. Guildford Soroptimists says:

    Local council cuts and lack of integrated services across council boundaries is a major obstacle to integration. Local responsiveness is key as demographics vary considerably. However when you live in a small corner of a county with 2 adjacent counties it is too eay to see how lack of integration can have such a devastating effect. It is not a ‘Post Code Lottery’, the post codes stretch across council and country boundaries, it is a council and county lottery.

    There should be easily accessible lists of agencies, voluntary and statutory, for all who need them, independent of the medium they are published on.

    But working across border is a truly important concept, paricularly in these difficult times.

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