The hypothesis for integration of care is that if there is a clear vision to make a difference to service users, and to monitor progress, and if health and social care resources are concentrated on the people who most need them, at the right time, there will be better outcomes and less wasteful use of resources.   National Voices have produced a narrative about integrated care from the personal perspective of patients, service users and carers (February 2013).  Its top line is:

People want co-ordination. Not necessarily (organisational) integration.
People want care. Where it comes from is secondary.

The DH Long Term Conditions Quality Innovation, Productivity and Prevention (QIPP) workstream is promoting three key drivers to integration:-

• Risk profiling of patients: so that their conditions can be continually monitored and changes responded to with prompt, effective interventions that prevent admission. (see our Predictive Risk page).
• Integrated care teams: treating and supporting the person, rather than the condition, thereby delivering holistic, joined up, productive care.
• Patient self-care and management: viewing patients as experts in their conditions and empowering them to access the care and support they need, when they need it.  (see our Personalising Care page).

They propose all three need to be implemented to achieve the desired QIPP progress. Our case study from Northumbria exemplifies this.

Good practice examples

See these pages for:

General respiratory service examples

COPD examples

Asthma examples

Oxygen examples

See webcasts

See left hand menu for further options

IMPRESS publications

How to improve quality and productivity by integrating COPD care
IMPRESS synthesis of current evidence and policy, illustrated by our report on North Tyneside, one of two national (England) integrated care pilots focusing on COPD
Download full report  here.

• The requirement to find efficiency savings of 4-5 per cent a year requires fundamental changes in the way hospitals are used
• A transformation of systems to provide value for people with long term conditions is seen as critical to success
• The potential for better coordination and for integrating care across a pathway linking home, primary and community services, hospital and social care is considered by policy makers to be significant, but there are as yet relatively few examples of real success
• The hypothesis for integration is that if there is a clear vision to make a difference to service users, and to monitor progress, if health and social care resources are concentrated on the people who most need them, at the right time, there will be better outcomes and less wasteful use of resources
• This paper describes work in progress in North Tyneside, Northumbria, one of the national integrated care pilot sites, that includes patients with COPD in its scope
• It also draws on recent reports and analysis from the Nuffield Trust and the Kings Fund as well as the interim report of the national pilots by RAND Europe, Ernst and Young and  Department of Health England
• We illustrate how changes in re-ablement funding might be used, whereby £150m in 2011/12 and £300m in 2012/13 will be transferred from NHS funding to social care for post-discharge support and re-ablement
• We suggest the bundle of activities that are needed: care planning, allocation of a key/named worker, routine measurement and feedback to primary care, robust patient assessment and referral to key services such as pulmonary rehabilitation, education and support for patients and professionals, and recording and provision of consistent information across primary and secondary care
• We show how investment in relationships over time pays dividends and how much can be achieved outside the commissioning system, by providers alone
• In Northumbria the staff group who have made the biggest changes have been the community nursing staff for whom detailed proactive management of an individual with a long term condition has not traditionally been part of their role
• What is happening in Northumbria shows the potential impact of integrated care on patient experience,  quality of diagnosis, care and admissions
• It also shows how general practice, supported appropriately by hospital specialists and social care specialists and working in a culture of trust can drive system change for the benefit of patients
• It explains the potential for social care services such as support for carers and community alarm services as well as home support to be better integrated into care pathways to support patients
• It makes the case for a consistent care approach to other long term conditions, particularly heart disease and diabetes, and for regular medication review
• Finally, it demonstrates four sorts of integration: centred on an individual irrespective of long term condition(s), between primary and secondary care decision-making, between general practice and community nursing and between health and social care.

Kings Fund reports and other latest updates see here.

Other resources

Kings Fund www.kingsfund.org.uk
Nuffield Trust http://www.nuffieldtrust.org.uk/
http://healthandcare.dh.gov.uk/integrated/
http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPPworkstreams/DH_115448