There are at least 175 different definitions of integrated care according to The King’s Fund. And it has a fair few names too, including ‘coordinated care’ and ‘joined-up care’.
So would another definition and a narrative of integrated care really help anyone?
Well, yes, there is room for a definition with a difference: a definition we can all agree on.
If we are to crack this challenge once and for all, if we are to stop patients falling through gaps and unravel the maze of health and social care that people have to navigate at the most stressful time in their lives, then we need a shared aim, a united vision. And we need some context around this, something that really helps in planning services.
National Voices has been commissioned by the NHS Commissioning Board to develop this and we hope commissioners across the country will join us in refining it so that it will help you make an impact in your work.
So far, we have worked with patients, service users, carers and their families, alongside the commissioning board, the Local Government Association, the Department of Health and Monitor to set out an overall definition, which is that integration means person-centred co-ordinated care so a patient would describe their experience as:
‘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.’
We have called it ‘co-ordinated care’ rather than ‘integrated care’ because co-ordination is what patients want and it is more meaningful to most people. Whether services are integrated in a formal, structural sense, is less important – that may or may not be a way of achieving the outcomes.
We have also set out a series of ‘I statements’ for context. Here, the aim is to give meaning to the basic profile of ‘Mrs Smith’ or ‘Mrs Carlisle’ – that is, to help planners picture the benefits of the new arrangements if we keep the focus on the goals and outcomes for service users. We hope they will be useful in setting performance indicators. Examples of ‘I statements’ include:
‘I worked with my main professionals to agree a care plan.’
‘My care plan was clearly entered on my record.’
‘When I went to a new service, they knew who I was, and about my own views, preferences and circumstances.’
In the current version these are structured into the themes of: goals/outcomes; communication; information; decision making; care planning; transitions and emergencies. Going forward, specific sets of ‘I statements’ will be developed for groups of service users for whom the general set does not cover all of the most important aspects of co-ordinated care, such as children with disabilities who have education and developmental needs.
The Commissioning Board will adopt the completed ‘narrative’ and the aim is that all system leaders, commissioners and providers feel able to adopt it too – and will pledge to work to achieve it.
We do hope you are able to give us some feedback to improve the draft so that you - and indeed all health and care professionals - feel you can sign up to this. We are particularly keen to hear to what extent it looks like something that will help you in your planning and service design, and what could be changed to make it even more useful.
Please click here by 28 February to respond. Thank you in advance for your feedback.
Jules Acton is director of engagement and membership for National Voices, the health and social care charity coalition.