Health and social care integration: how do we make it work?

Integration should carry a strong emphasis on patient leadership and patient outcomes, says Chris Hopson. Photograph: Alamy

Public sector management goes through waves of mania for particular buzzwords and concepts. In health and social care, "integration" is the latest mantra for improving care.

While our health and social care system often divides and separates us – think organisational structure, payment mechanisms and performance targets, for example – we are all in this to improve care for patients. We are at our best when we focus on that, and at our worst when we forget it. Integration is a perfect example of this truism.

When some people talk about integration they actually mean organisational and provider integration – creating single accountable care organisations or lead providers. Others mean integrating commissioning – bringing local authority and health commissioning together into a single place.

Some mean improving collaboration and co-ordination with the voluntary and other sectors. Yet others mean integrating governance – for example, creating health and wellbeing boards. And there are yet more who mean integrating finance – for example by pooling budgets or creating integrated health and social care funds. They're all integration, they're all important steps, but none of them, by and of themselves, directly improves patient outcomes.

That's why if we are to use the i-word and concept (and some are wondering aloud if we should drop its use altogether, given the confusion), we should get the right definition. The Integrated Care and Support Collaborative's definition, for example, carries a strong and welcome emphasis on patient leadership and patient outcomes: "My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes."

So when I'm asked what integration means for me, I talk about the joint emergency team I visited recently in south-east London, where patients facing a social, mental or physical emergency that can be dealt with out of hospital now have a single point of referral. The joint team can react incredibly quickly and make a holistic assessment of all their health and care needs together and then ensure that the right package of integrated care is quickly put in place.

All that has been achieved thanks to Greenwich council, Oxleas NHS foundation trust (the local community and mental health trust) and the local acute trust coming into a single team, working holistically and pooling budgets. But what counts most are the dramatically improved patient pathways and outcomes that have resulted. And when you visit the team, it's improving the patient outcomes that patently came and come first.

As the new director general for social care at the Department of Health, Jon Rouse, pointed out at the Department's last national stakeholder forum, international best practice suggests successful, patient-focused, integrated health and care systems share 11 common features:

• Strong clinical leadership across sectors and disciplines
• Use of data driven processes to drive improvement
• Multi-disciplinary teams built round primary care practitioners
• Strong investment in preventative services to improve patient self management
• Use of risk stratification and proactive assessment and care planning
• Effective care co-ordination in crises, starting in A&E, including social and mental health care and through to discharge
• Seamless transfer between acute and community settings, backed up by continuous dialogue between the lead primary care practitioner and hospital consultant
• Single electronic care record with patient access/interaction
• Both integrated commissioning and integrated provision
• Integration between physical and mental health services, with similar access standards
• Same incentives across system – outcomes, process, user experience, value for money.

It's worth quoting the list in full because, like me, you'll probably go through it and mentally check how many of these features are in place where you are. Far too few, I suspect, which is certainly the case for the English NHS as a whole, where the Foundation Trust Network has its focus. These are the areas we need to focus on if we are to deliver patient-centred integration at the scale and pace required.

So full marks to all three of our main political parties, who are now competing to be best at integration. Congratulations to those trusts and local health and care economies that are pioneering new ways of working.

But let's please ensure that the move to integration improves patient outcomes and doesn't just end up making organisational, governance, budgetary or structural changes that do little to change patient pathways. In a phrase, integration: it's the patient, stupid.

Chris Hopson is chief executive of the Foundation Trust Network

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