How will greater collaboration change the NHS?
In the video you’ve just watched, you saw what greater collaboration between different services might look like for a patient like Sam. But it isn’t just older patients who could benefit from more integrated care. Every day in the NHS, patients have needs that span different services and beyond health care.
Integrated care happens when health and care organisations work together to meet the needs of either individuals or local populations. Sometimes, integrated care can involve local authorities and the voluntary sector in working towards these objectives alongside the NHS. The most ambitious forms of integrated care aim to improve population health by tackling the causes of illness and the social factors that influence health.
Why the move towards integration?
When the NHS began in 1948, the primary purpose of the health service was to provide treatment for short periods of ill health. Due to technological and medical advances, and changes in society and the population, the challenges that face the NHS today have changed. People are now living longer and with long-term health conditions, and often with more than one condition. This means that people increasingly need long-term care and support from lots of different services and a variety of professionals. These different services are often organised in silos and for patients, this can result in a poorer experience of care because of the lack of co-ordination and communication between all the different services and people involved in their care.
Budget pressures, combined with rising demand from a growing and ageing population, have put the NHS under great pressure. Integrated care may not necessarily save money for the NHS but it could help to improve patient experience and outcomes and lead to a more efficient health service.
So integrated care focuses on joining up care to improve services and the care that patients receive. It aims to encourage the NHS and its partners to work differently by providing more services closer to people’s homes and breaking down barriers between different organisations. The benefits of this have been recognised by the NHS in the recent NHS long-term plan which includes a range of actions to support greater collaboration:
- changes to the way that services are funded to support and incentivise integrated care
- the development of tools to enable services to identify people who are at risk of poor health and health inequalities
- potential changes to the law to enable greater collaboration and to reduce the role of competition in the NHS.
What does integrated care look like?
There are lots of models of integrated care and many different forms of collaboration. The majority of approaches to integrated care so far have focused on providing joined up care around a patient, like in Sam’s Story, or around defined groups of people. This might involve better collaboration between health and social care. This particularly benefits people with complex health and care needs, including individuals living multiple long-term conditions, mental health conditions or learning disabilities and older people, as these groups are most likely to access both health and social care services.
Other approaches to integration have focused on joining up services within the NHS itself, such as physical and mental health services. People with a mental health condition are more likely to also have a preventable physical health condition such as diabetes, heart disease or cancer. There is good evidence that addressing mental and physical health needs together is better for patients and can be more cost effective.
Over time, thinking on integration has developed and expanded beyond health and care services. As you learned in Week 1, health care contributes to only a small proportion of our overall health. Other factors, such as housing, the environment and our communities, make a much larger contribution to our wellbeing. As well as joining up health and care services around individuals, what if wider voluntary and public services were more joined up in planning for the needs of people living in a particular area? This might mean that health, housing, education, police, fire and leisure services all work together as a population health system to plan their services and improve the health of their community.
How is integrated care being carried out at the moment?
There have been many national initiatives to integrate care over the last three decades. Some of the key initiatives from recent years are set out below:
New care models
These were introduced in NHS England’s 2014 plan, the NHS five year forward view. The plan outlined several ‘new models of care’, designed to bring together different health and care services within local areas. 50 areas of the country were selected to develop these models.
Sustainability and transformation partnerships (STPs)
In 2015, NHS organisations were directed to come together to form local partnerships of NHS organisations and local authorities. There are 44 STPs in England and each one covers an average population size of 1.2 million people. They were tasked with producing ‘sustainability and transformation plans’ outlining how local organisations would work together and how improvements would be made to the quality and efficiency of care and people’s health and wellbeing. They were also tasked with demonstrating how their local system would achieve financial balance. The initial plans were controversial due to the way they were produced and some of the suggestions they contained around saving money. Many STPs are no longer planning to deliver the proposals in their initial plans, but they are finding ways for local organisations to work more closely together through the local partnerships to plan and deliver improvements in local services. They are expected to take an increasingly important role in planning and managing services in the future.
Integrated care systems (ICSs)
In some areas of the country, NHS organisations are working together to develop integrated care systems. These are intended to be ‘mature’ or ‘evolved’ STPs where local organisations will work collaboratively to take collective responsibility for planning and managing local services. ICSs vary widely in their size and complexity. Some of the larger ICSs have local partnerships within them that are focused on joining up the delivery of local services. 10 areas of the country were chosen to lead the development of ICSs. It is very early days and the ICSs are still evolving, but there are some promising indications that they are beginning to make progress in driving closer collaboration and making improvements in care. The NHS Long-Term Plan confirms this continuing shift towards greater integration and commits to a target of full ICS coverage across England by April 2021.
Primary care networks
Introduced as a key building block of the NHS Long-Term Plan, primary care networks bring together groups of GP practices to work alongside community health services, mental health services, social care, pharmacy, hospital and voluntary services. GP practices in England are expected to come together in these networks, covering populations of approximately 30-50,000 patients by June 2019. Primary care networks have the potential to benefit patients by offering improved access and extending the range of services available to them, and by helping to integrate primary care with wider health and community services. The hope is that they will improve the ability of practices to recruit and retain staff; to manage financial pressures; to provide a wider range of services to patients and to more easily integrate with the wider health and care system.
All these developments hold the promise of a different way of working for NHS services with an emphasis on places, populations and systems. However change is not easy. As you have already learnt, the NHS in England is based around separate organisations and the structure of the system doesn’t currently encourage collaboration. However, the NHS Long-Term Plan included suggested legislative changes to help implement the Plan easier and faster. The proposed changes include allowing joint decision-making between providers and commissioners and reducing the role of competition in the NHS.
Think about your own experience of health care. Can you think of ways in which better partnership and collaboration between services could have made your experience better?
© The King’s Fund