As a GP and public health doctor, I have plenty of experience of care that hasn’t been properly joined-up.
I have seen, too many times, patients repeating their story again and again to different health and care professionals. I have seen too many doctors, nurses and administrators wasting hours searching for information that hasn’t been passed from one part of the system to another. I have seen dedicated community nurses, social workers, GPs and therapists all providing care that either overlaps with or contradicts care provided by other health and care workers.
The benefits of integrated - that is, properly joined-up - care are, for most people, self-evident. While many aspects of the integrated care debate may seem somewhat technical, it is an issue that is absolutely critical to the needs of many of my constituents in Stockton South, and indeed, to people across the country.
‘New care models’ have had some success in facilitating change. However, pilot schemes have been accompanied by significant additional funding. That may well be a key factor in their reported success. What usually happens is that pilots get an injection of resources for double-running costs, and the subsequent roll-out fails through under-funding. We need assurances that as other areas move towards adopting similar models, this won’t happen.
The current NHS is very focused on reducing unplanned hospital admissions. While this is important, especially financially, Integrated Care Providers (ICPs) must try to achieve broader health goals. Success shouldn’t be measured by a reduction in secondary care activity alone.
ICPs will provide health care for a population of people. They must take a needs-based approach to health care, which involves communities and considers the health of the population as a whole. We know that loneliness, social isolation and bereavement can have a huge impact on health; we need integrated care to be integrated holistic care.
A clever health care system doesn’t just react to the people who turn up – it works within communities to identify and address needs. ICPs will have succeeded if resources are focused on improving the health of the people with the greatest needs. The so-called ‘inverse care law’ tells us that those with the greatest health needs often have the least access to health care.
For example, many of my constituents with mental health problems don’t manage to access the care provided by the NHS – and their physical, mental and social health suffers as a result. Similarly, people with learning disabilities die, on average, 15 years younger than those without – and they don’t die of their learning disabilities. We know that people living in poverty are more at risk, as are people who misuse substances, homeless people, veterans and vulnerable migrants. It’s heart-breaking, both as a GP and an MP, to know that if these people had received the right kind of support earlier on, then their wellbeing could have been significantly improved.
Prevention needs to be prioritised, at all levels. Better early detection, better immunisation and screening coverage, better prevention of falls, and better prevention of mental health problems. Unless we make this a primary concern for the NHS, it will continue to face pressure, and crises like those we’ve seen recently will become the norm.
Integrated care has to be the way forward. But it can only be successful if the share of NHS spending that goes to primary care, community care and mental health services increases year-on-year. The area that needs the greatest investment in integration is outside of hospitals – community care, social care and primary care are, at the moment, far too fragmented. In many areas, the team of people caring for an individual all work for different organisations and haven’t agreed a co-ordinated plan with the patient.
Going forward, we need to consider legislation to support the changes. Under current rules, Clinical Commissioning Groups will remain the statutory accountable bodies. However, Sustainability and Transformation Partnerships (STPs) - the bodies which will evolve into Integrated Care Providers are places of opaque decision-making. If they are to be properly accountable, we need much greater transparency in their governance.
One of the biggest barriers to integration is the resistance on the part of some NHS providers to share information with other parts of the health and social care system. We may also need legislation, therefore, to ensure that the duty to share information - when it is in the best interest of patients - is properly enforced.
Furthermore, integration can’t be achieved if the law – or at least the interpretation of it - continues to insist on services being put out to competitive tender. If we, as elected politicians, want the NHS to collaborate, then we should legislate for collaboration.
There is a well-founded concern on the part of the health and care community – and indeed, on the part of many of my constituents who have taken the time to contact me about the issue - that under current legislation, private companies will bid to win contracts to provide large chunks of our health service.
In the absence of integration, we will continue to see fragmented care, unplanned hospital admissions, pressure on frontline services, and the most vulnerable members of our society will continue to suffer. Our NHS is currently fragile. Getting integration right offers the hope of a better future. It is beholden on politicians to step up and provide the legislative framework that enables this.
Dr Paul Williams is the MP for Stockton South and a general practitioner. He is a member of the Health and Social Care Select Committee and recently contributed to a House of Commons debate on a report into integrated care.