Integrated care – it’s time to walk the talk

Another year, another overflowing A&E crisis. Unfortunately this has been a recurring thing in recent years, but this year it’s been worse than ever with some hospitals even declaring a 'major incident'.

The NHS coped admirably under severe pressure as the number of people attending A&E increased, with fewer people were being treated within the four hour target time frame. A tent was erected in the car park of Great Western hospital in Swindon in order to make extra room for patients to be treated. The pressure on hospitals was exacerbated by patients who attended A&E and then required further attention elsewhere in the hospital. Patients were left on trolleys for hours on end, while the doctors and nurses around them struggled to find sufficient beds.

There was certainly intense political debate surrounding the crisis – but what is the solution?

While there can be no single remedy, the care of older people is an element which needs to be looked at closely as a way to help reduce the burden on A&E departments, and hospitals in general. The UK has a rapidly ageing population which increases pressure on our healthcare system. This is recognised by politicians who have spoken about integrated care as a way to manage this growing population.

Global management consulting firm McKinsey & Company have defined integrated care as a system which “brings together the different groups involved in patient care so that, from the patient’s perspective, the services delivered are consistent and coordinated. …[It] offers patients higher-quality, more efficient care that better meets their needs. In many cases, the increased efficiency also helps control costs.”

Integrated care is already provided to a very high standard in countries such as Sweden, and it goes a long way to ensuring that elderly people are able to receive the best and most appropriate care, in the community, at the time they need it. There are integrated care initiatives in the UK, such as in Kent, South Warwickshire and Central Manchester, but there can be no doubt that there is still a long way to go until integrated care is the norm.

In October 2014, NHS England’s Chief Executive Simon Stevens published his Five Year Forward View which set out a clear sense of direction for the way healthcare services need to change and improve, along with the request for an extra £8bn by 2020 to make it happen. Integrated care featured heavily in this plan, as a way of delivering sustainable and patient-centred care. Both the Secretary of State for Health and the Shadow Health Secretary claimed the Five Year Forward View supported their respective parties’ policies for the future of the health service. But, it is the Liberal Democrats who have gone that step further and pledged to meet the £8bn funding target as part of their 2015 Election Manifesto.

As we get closer to the General Election in May, we will see the UK’s healthcare system at the forefront of political debates. Under a Conservative-Liberal Democrat coalition, negative headlines about the NHS play well for Labour. The Leader of the Opposition Ed Miliband has even been accused of planning to ‘weaponise’ the NHS ahead of election. Weaponised or not, Labour has also recognised the importance of integrated care as part of the provision of healthcare services, and outlined its view of a system of ‘whole-person care’ in its pre-manifesto thinking.

The Conservatives have acknowledged the value that integrated care can bring to the healthcare system. In 2013, the Government set up the Better Care Fund, creating local pooled budgets to incentivising local authorities and the NHS to work more closely together in a move towards integration. In his party conference speech in 2014, Jeremy Hunt praised the success of this scheme in areas across the UK, but acknowledged the need to go further to deliver personal and integrated care for every NHS patient.

In other words, there is a great deal of talk about integrated care, but only very little action. Rather than spouting political rhetoric, politicians need to take a firmer grasp of the situation and act, because the task is huge.

My view is that fully implementing integrated care into the UK’s healthcare system involves such a seismic change of attitude for the NHS, that it needs political impetus to make it happen.  Could this A&E crisis prove to be the catalyst? For real change to take place, the concept of integrated care needs to move from the politician’s desk to the public consciousness, to ensure their understanding and co-operation. A General Election would seem like the perfect time to put integrated care on the political agenda.

Zoe White is a PLMR Account Executive specialising in health and social care.

This article was first featured in the February print edition of Healthcare Business News.

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