Delivering integration care can be done

David Lenihan, Agilisys Health & Social Care Practice writing in the Local Government Chronicle.

Demands on services are rising while budgets continue to shrink. An ageing population, rising life expectancy, proliferation of chronic and lifestyle-related diseases - the challenges facing anyone delivering, commissioning, supporting, monitoring or consuming health and social care services are well documented - as is the unfortunate truth that, without action, these trends threaten the future affordability and quality of the care delivered.

Time for action

So what can we do? National policy is emphasising the need for integrated care. Yet, despite decades on the government's policy agenda, we have too few examples of good integrated care within the UK. There is a relative paucity of UK evidence and no local 'well-trodden paths' for us to follow.

We believe that the pace of progress is not a reflection of capability or ambition; it simply reflects the simple but often side-stepped fact that achieving integrated care is difficult. It is difficult because across the continuum of care, our system has:

• Many different physical care settings
• Multiple commissioners and providers, each with different priorities, perspectives and agendas
• An excess of assessments, leading to duplication of effort and poor experience for patients forced to repeat their stories multiple times
• Incentives that are not aligned to support integration
• Fragmented funding and discrete professional cultures
• Disjointed and fragmented IT systems and patient/service user records.

Despite these challenges, our research indicates usable and practical solutions do exist, do deliver and should be carefully considered in the UK.

Integrated care holds promise and the progress made in places such as New Zealand, Scandinavia and Canada provides invaluable evidence about what integrated care can achieve.

The interRAI example

Perhaps New Zealand offers the most valuable insights. As lauded by the Department of Health in the NHS IT strategy, New Zealand has made significant and rapid progress integrating care across social care and health boundaries.

Key to New Zealand's success is the use of the suite of evidence-based tools developed by global nonprofit healthcare network interRAI, which has facilitated multidisciplinary and integrated working.

interRAI tools - such as standardised and personcentred care plans, rigorous evaluation, carefully measured outcomes and reimbursement tools allowing for equitably funded care - have been key in delivering benefits seen not only in New Zealand but in more than 30 locations across the globe. Within a range of health and care structures as diverse as the US, Italy, and China, such benefits have included, for example, £1bn in savings cited by the US state of Michigan, and reduced levels of hospitalisation, institutionalism, mortality and morbidity.

We know that there are no magic bullets to resolving the issues we have lived with for many years, but there is a clear need to address the difficult challenges. And that is why Agilisys is working closely with clients and partners to explore the use of international standards like interRAI, which offer us immediate opportunities to achieve better care.

While there is no one formula for success, Agilisys' reflections on the evidence and experiences of our partners, clients and others can be summarised into a few key principles:

• Good care services, where integrated across the entire continuum of care, will reduce costs and improve people's quality of life
• Organisational form should follow function. Organisational integration alone is not enough and it rarely delivers integrated care. Investments to coordinate and improve care should be made at the practice level
• Integrated care pathways for single conditions will not solve the problem. We must think in terms of 'whole person' and 'whole system'
• Standardised, comprehensive and multi-dimensional assessments are the linchpin of highquality integrated care. They underpin person-centred care planning and provide the platform for integrated working by enabling multidisciplinary professionals to coordinate their activities
• Integration and/or interoperability between our IT systems is needed in order to provide a single view of service users
• Robust and validated standards are needed - especially in relation to assessments, outcomes, quality indicators and joint reimbursement models.

None of this can be achieved without strong leadership and initiative. We know it's not easy. But we know it can be done.

None of us knows when we may need to call upon care and health services - but we do know that we all have a part to play in making them the best they can be, and by working together we can address these difficult issues and turn integrated care from a challenge to a reality.