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Breaking down barriers

Breaking down barriers

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Integration needs to be well planned and evidence-based in order for it to actually lead to improved care

Earlier this year I was fortunate enough to be invited to attend Commissioning Live at the Royal Armouries in Leeds, and the Clinical Commissioning Leaders’ dinner that evening.

The conference was chaired by Dr James Kingsland, president of the National Association of Primary Care and the keynote speakers were Norman Lamb, Minister of State for Care and Support, and Malcolm Grant, Chair of the NHS England.

Lamb’s speech was most thought provoking as he hit upon some key themes about which I am passionate. 

His main concern was about the institutionalised fragmentation between primary and secondary care, and health and social care, with the distinct possibility that patients might fall through the gaps. 

It is also a huge challenge to achieve the higher standards being demanded with the limited amount of money being made available.

He felt that it was really important that we challenged the institutional barriers, and gave examples of how the health system and local government were working effectively together.

He hit upon four key themes, namely:

 - Contracts - we are currently incentivising activity in acute hospitals, whereas we need to challenge the payment system and reform it in line with the needs of local patients. It doesn’t make sense to pay on an episodic basis, and something like the Year of Care tariff – which is being piloted at seven sites across the country – should be testing a different model.

 - The importance of leadership – these changes will only happen if we can cut across organisational boundaries and encourage better integration, with leaders in the emerging health and wellbeing boards holding the purse strings.

 - Capability – we need the tools and skills to integrate in the first place, and there will soon be a framework on normalising integrated care, based upon the need to share tools and innovations to make integrated care happen. There also needs to be a national knowledge-sharing network to share good practice.

 - Evidence – we need to identify what best practice actually is, both overseas as well as in the UK. Innovations are happening (the Year of Care, personal health budget pilots, etc) but this needs a network of pioneers to bring the necessary expertise and enthusiasm – a much more effective way of bringing this about than through legislation.

The themes listed above should bring about a shift change in the way we practice, as follows:

 - From fragmentation to integration, focusing on the needs of patients.

 - Focus from ‘repairing’ to ‘preventing, maintaining wellbeing and keeping patients out of hospital.

 - To encourage the patient as a partner in care, central to everything we do.

 - From exclusive to inclusive care.

 - From doing things to patients to innovative collaborations, between health, local authorities and the community and voluntary sector.

 - From treating illness to maintaining independence and encouraging the patient to live a happy, healthy life.

Lamb has launched a pioneer programme of sites throughout the country, serving the patient interest and improving health and wellbeing as pre-requisites for entry to the programme.

There are good examples of pioneering in other countries, for example with Kaiser Permanente in the United States, a not-for-profit organisation focusing on integrated care and preventative health messages.

I am currently working with commissioners and clinical leads in my local clinical commissioning group (CCG) to help redesign innovative, patient-centred primary care services with a focus on early intervention and primary prevention. 

The key challenge for us is that, if we invest in innovative services, we need to disinvest elsewhere in the health and care economy. 

In my opinion, this means a shift of money from the acute care setting (non-elective emergency admissions) to early intervention on the front line. 

This will not be a popular move politically – no politician wants to see the closure of hospital beds in their patch – but is a necessary shift if we are to achieve the changes described above and deliver clinically effective, cost-effective care in our localities. 

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