This document discusses integrated health and social care. It begins by explaining that integrated care is important due to rising chronic disease in an aging population, increasing hospital admissions, and fragmented care coordination. The second section defines integrated care as having the patient perspective at the heart of service delivery. Common barriers to integrated care are then outlined, such as differing health and social care systems and a lack of electronic patient records. Finally, ten steps are provided for making integrated care happen, including developing new care models, aligning financial incentives, and evaluating changes over time.

1. Integrating health and social care
Dr Judith Smith
Head of Policy
The Nuffield Trust, London
Age UK Agenda for Later Life Conference
London, 8 March 2012
© Nuffield Trust

2. Agenda
• Why does integrated care matter?
• Understanding integrated care
• What gets in the way?
• How do we make it happen?
© Nuffield Trust

3. Why does integrated care matter?
• Rising levels of chronic disease within an ageing
population
• Increasing levels of hospital admissions and
readmissions, especially among the elderly and vulnerable
• Economic hard times, and unsustainable health and social
care economies
• And too often we still do not get it right in terms of care co-
ordination, care planning, communication with families
• Somehow, care for frail people with complex needs is not
the pressing priority it needs to be
© Nuffield Trust

4. Understanding integrated care
A definition of integrated care:
‘The patient’s perspective is at the heart of any discussion
about integrated care. Achieving integrated care requires
those involved with planning and providing services “to
impose the patient perspective as the organising
principle of service delivery”’
(Shaw et al, 2011, after Lloyd and Wait, 2005)
© Nuffield Trust

5. Understanding integrated care
This is about safety and quality
‘achieving integrated care would be the biggest contribution
that health and social care services could make to
improving quality and safety.’
National Voices, 2011
• Care for people with complex needs has to be made a real
and pressing priority for funders and providers
• First of all however, we need to understand how care is
currently fragmented
• We need to measure people’s experiences across and not
just within organisations
© Nuffield Trust

6. © Nuffield Trust

7. What gets in the way?
• The health and social care divide, with different funding
streams, provider systems, and culture
• The general practice-hospital divide, and the models of care
that have their roots in this
• The persisting weakness of NHS commissioning
• NHS management culture that talks about innovation yet
acts ‘permission-based’ and risk averse
• The absence of a robust shared electronic patient record
• Perverse payment and funding approaches
• Lack of clarity re care co-ordination and management
© Nuffield Trust
(Goodwin, Smith et al, 2012)

8. How do we make it happen? (Goodwin, Smith et al, adapted)
1. Provide a compelling and supportive narrative – make the
case for patients and carers, explain the need for change
2. Relentlessly measure patient and carer experience, so that
you understand the extent of the problem and have
benchmarks against which to improve
3. Develop new models of care, and approaches to care co-
ordination that can address the needs exposed
4. Explore what these mean for the future of general practice,
community services, social care, and hospitals
5. Back innovative sites and give them time and resource –
sites need at least five years to test new ways of working
© Nuffield Trust

9. 6. Plan for the longer term, for example what 24/7 primary
care-based support for integrated care will look like
7. Align financial incentives by allowing funders flexibility in
use of tariffs and other contract currencies
8. Explore ways of ensuring user choice within integrated
care developments – how care is provided, where, when
9. Evaluate in a robust manner, over time, and including
activity, cost, quality and patient experience
10. Make integrated care matter – set a clear, ambitious and
measurable goal to improve the experience of patients and
service users
© Nuffield Trust

10. In conclusion
• It does not matter whether we talk about ‘integrated
care’, ‘co-ordinated care’, ‘joined up services’ or ‘integrated
delivery systems’
• These are all ultimately health and social policy jargon
• What matters to families is that frail and vulnerable people
get the services they need, in a timely manner, and
delivered with compassion
• Given the degree of frailty people have and the complexity
of their needs, we have to find new ways of
anticipating, planning for, and meeting these
© Nuffield Trust

11. References
Goodwin N, Smith JA, Davies A, Perry C, Rosen R, Dixon A, Dixon J (2012)
Integrated care for patients and populations: improving outcomes by working
together
Lloyd J and Wait S (2005) Integrated care: a guide for policymakers. London:
Alliance for Health and the Future
National Voices (2011) Principles for Integrated Care. www.nationalvoices.org.uk
Shaw S, Rosen R and Rumbold B (2011) What is integrated care? London, the
Nuffield Trust
© Nuffield Trust

12. www.nuffieldtrust.org.uk
Sign-up for our newsletter
www.nuffieldtrust.org.uk/newsletter
Follow us on Twitter
(http://twitter.com/NuffieldTrust)
March 2012 © Nuffield Trust