What does a good integrated care system look like?
The debate between finance and quality has always been ripe in the NHS, more so during recent years with increasing financial challenges. Often deemed as two sides of the same coin, the NHS has been trying to find the happy medium of creating a more integrated system which improves quality within sustainable finances, while at the same time dissolving some of the traditional boundaries.
The journey towards an integrated care system
The Five Year Forward View, published in October 2014, focused on integration of services around the patient to simultaneously close the health and wellbeing gap, the care and quality gap, and the funding and efficiency gap. Since then, multispecialty community providers (MCPs) and primary and acute care systems (PACS) vanguards have been the nucleus of change for the NHS and there has been a proliferation of different initiatives that have focused on managing healthcare for a defined population. In parallel, primary care has been developing at scale since the creation of clinical commissioning groups (CCGs) in 2012, the development of GP federations and the more active role of primary care within sustainability and transformation partnerships (STPs) and vanguards. The new models of care have been reviewed and evaluated over time to make improvements and to learn from them, as well as to stop the ones that are not working, or are overlapping.
While many of the initiatives implemented have been small and local in places, they have provided an opportunity to build on, to enhance coverage for a wider population, forming the building blocks of integrated care systems (ICSs) and population health management within the NHS.
Focus on the right interventions
The focus needs to be on systematic, incremental change, and not on big-bang transformation – starting with the things you know you can influence that have impact. It’s equally important to get the patient view by engaging with the patients and service users and asking the right questions: for example, to understand why people choose to go to the hospital; what would make a new service more attractive; and what would be needed to change public perceptions and design the future right. There needs to be a continuous dialogue and consensus amongst stakeholders around the purpose, delivery and value of the integrated service models.
Where to next?
There is no silver bullet for integrating health and care systems, and system transformation will be delivered by collaboratively focussing on the interventions that work, and systematically scaling them over time. However, it does require a robust approach. Agile programme delivery, supported by continual evaluation will help you measure whether you are achieving the outcomes you want for your population.
To guide you on the incremental steps that you could take to become an ICS, we’ve created a practical guide to establishing an integrated care system (ICS), consisting of guides, opinion pieces and case studies. We draw upon our experience of supporting the transition from pathfinders to vanguards and STPs and with emerging integrated care systems.