This piece was commissioned in response to this post by Peter Kellner on the ongoing NHS "crisis"
Peter Kellner’s story perfectly illustrates the Achilles heel of the NHS. Individual episodes of care may be excellent but too often continuity and coordination are lacking. This results in gaps and delays in treatment, causing patients to suffer anxiety and outcomes of care to be affected.
The King’s Fund has led the argument for care to be more integrated around the needs of patients and this argument has now been accepted by the three main political parties. But what is integrated care? For patients, it means having someone who helps to coordinate their care and ensures continuity. In some cases this may be a GP while in others it could be a community nurse or a hospital clinician.
Integrated care is especially important for the growing number of frail older people with more than one medical condition who are in contact with several health and social care professionals. The renowned US surgeon and Reith lecturer Atul Gawande argues that these professionals need to emulate the example of highly trained formula 1 pit crews instead of acting as lone cowboys on the range. His point is that healthcare is increasingly delivered by teams in which the results for patients depend more on the contribution of each member than the deeds of one heroic doctor or nurse. Effective team working is crucial to unlocking the benefits of integrated care.
Care coordination for individual patients requires collaboration between different agencies, both within the NHS and between the NHS and other sectors. Local government plays an especially important role with its responsibility for social care and now also for public health. The divide between health and social care that originated in the post-war settlement, which established the NHS as a universal service, free at the point of use, and social care as a separately funded means-tested service, is a major barrier to integrated care and must be overcome to provide services fit for the population of the future.
In some parts of the country the NHS is already demonstrating what can be achieved. Torbay has a long history of health and social care integration for older people. Greenwich has focused on integrating through locally based teams that are helping to reduce demand for hospital care. Northumbria has brought together hospital and community services with social care, and is now bringing GPs into the fold.
Technology plays an important part in developing integrated care. This includes the development of electronic patient care records to ensure that information about patients is readily available wherever they are seen. It also means using remote monitoring through telecare and telehealth to connect patients with health and social care professionals. Areas such as Airedale in West Yorkshire are pioneering these developments.
Atul Gawande has described the 21st century as the "century of the system". Staff as well as patients will hope that the next government will act on this insight. They should break down the organisational barriers and professional silos that get in the way of health and social care working as a system to deliver the best possible care at a time of increasingly constrained resources.
Peter Kellner’s story perfectly illustrates the Achilles heel of the NHS. Individual episodes of care may be excellent but too often continuity and coordination are lacking. This results in gaps and delays in treatment, causing patients to suffer anxiety and outcomes of care to be affected.
The King’s Fund has led the argument for care to be more integrated around the needs of patients and this argument has now been accepted by the three main political parties. But what is integrated care? For patients, it means having someone who helps to coordinate their care and ensures continuity. In some cases this may be a GP while in others it could be a community nurse or a hospital clinician.
Integrated care is especially important for the growing number of frail older people with more than one medical condition who are in contact with several health and social care professionals. The renowned US surgeon and Reith lecturer Atul Gawande argues that these professionals need to emulate the example of highly trained formula 1 pit crews instead of acting as lone cowboys on the range. His point is that healthcare is increasingly delivered by teams in which the results for patients depend more on the contribution of each member than the deeds of one heroic doctor or nurse. Effective team working is crucial to unlocking the benefits of integrated care.
Care coordination for individual patients requires collaboration between different agencies, both within the NHS and between the NHS and other sectors. Local government plays an especially important role with its responsibility for social care and now also for public health. The divide between health and social care that originated in the post-war settlement, which established the NHS as a universal service, free at the point of use, and social care as a separately funded means-tested service, is a major barrier to integrated care and must be overcome to provide services fit for the population of the future.
In some parts of the country the NHS is already demonstrating what can be achieved. Torbay has a long history of health and social care integration for older people. Greenwich has focused on integrating through locally based teams that are helping to reduce demand for hospital care. Northumbria has brought together hospital and community services with social care, and is now bringing GPs into the fold.
Technology plays an important part in developing integrated care. This includes the development of electronic patient care records to ensure that information about patients is readily available wherever they are seen. It also means using remote monitoring through telecare and telehealth to connect patients with health and social care professionals. Areas such as Airedale in West Yorkshire are pioneering these developments.
Atul Gawande has described the 21st century as the "century of the system". Staff as well as patients will hope that the next government will act on this insight. They should break down the organisational barriers and professional silos that get in the way of health and social care working as a system to deliver the best possible care at a time of increasingly constrained resources.
