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Integrated care must focus on people not structures

Posted by: , Posted on: - Categories: Communities, Integration

SCIE’s Ewan King suggests that, when it comes to integration, some individuals, businesses, and health and social care organisations spend too much time talking about structures and not enough about people. Time to reverse that ratio!

Ewan King: 'How do we avoid the lure of structural change? Involve people who use services and carers right from the start.'

This is certainly the case with the problem of fragmented health and care, which is often viewed as being just one more organisational restructure away from being solved. We know from years and years of enormous structural upheaval in the sector that this is simply not true.

Bringing organisations closer together - the goal of integrated care systems - is likely to be a good thing, but the focus on merging structures and reconfiguring governance arrangements across complex health and care systems could easily become disproportionate.

A further and continuing problem with the fixation on structures is that the primary focus has remained on the big statutory players - the NHS Trusts and local authorities - to the detriment of housing, voluntary sector groups and wider community assets.

Some of the most impactful models of integration, such as Age UK’s personalised care programme, are actually led by the voluntary sector; for instance Leicestershire's Lightbulb programme, which supports vulnerable people to stay independent.

In producing evidence recently for the Department of Health and Social Care (DHSC) on initiatives or interventions that have shown the greatest potential to improve outcomes and reduce costs, what comes out strongly is the importance of having excellent cross-system relationships and a clear focus on the person receiving the service.

So in Sutton, where they have delivered a successful Enhanced Care in Care Homes Vanguard, a huge amount of time has been invested in building trusting relationships between colleagues in social care and primary care - and the care homes. They have similarly invested in joint training.

How do we avoid the lure of structural change? Involve people who use services and carers right from the start.

Many of the best preventative services we have studied - and there are many examples on our website – have started with conversations within communities.

Out of these conversations emerged tailored services which brought together a range of professionals and agencies to support individuals - in short, integrated care.

One example is Cambridgeshire's Community Navigator scheme which supports older people to maintain their independence through lower level support. The scheme arose through conversations with communities.

None of this is to say that structural solutions are to be ignored. In places like North East Lincolnshire, where there is a single care organisation, joining up has been a key part of the solution.

But we should never neglect the need to focus on people and what they want, and on fostering good relationships across organisations.

Ewan King is Director of Business Development and Delivery at the Social Care Institute for Excellence

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  1. Comment by elaine Stringer posted on

    It is good to know that there are areas of the country interested in improving care for the elderly. I find that it is care of people already at home not using the services who are being missed out .
    No one seems interested in finding out about them unless they end up in hospital god forbid with bed shortages nurse and dr shortages.

    they really are the forgotten elderly.

  2. Comment by Andy Morrall posted on

    My experience of our parents being in hospital in different parts of the country is that it's not social care that's an issue as they are usually very responsive, given the cuts in services, but the NHS being totally incapable of planning ahead. Also local GPs have a lot to answer for as they are happy to see the problem offloaded to an NHS Trust to save them getting involved. Sort out the inefficiencies of GPs and Trust first!

  3. Comment by K woodward posted on

    Should be talking with and to people, not about them!
    Personalisation and person centre care with effective Carer communication would eradicate the waste of intervention resources, but common sense is not a factor in integrated care is it?

    The commissioning of contracts with private companies for integrated care needs to cease also, public money being handed over with no monitoring or accountability by the CCG s and care not being provided as publicly funded!

  4. Comment by Pearl Baker posted on

    Those suffering from LTC mentally ill placed into Supported Accommodation are off the radar and completely invisible 2 the system of integration, until Carers are accepted as part of the system nothing will improve. The National Audit office reported without Carers many would receive no Care and Support at all