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Do Integration Yourself

Bit tiresome isn’t it. Never-ending messages about what the NHS should be doing differently and better. But who and what to believe? 'Integration' is a buzzword that is so overused that many have lost sight of what it actually means.

We’re often told that greater integration between health and social care, and different parts of the health service, is hoped to achieve far-reaching health system goals such as improved quality and efficiency and is considered by many as the only viable future for the NHS.

Yet last year, more doctors than not told the BMA that they were either unsure or did not think that integration had the potential to produce desirable outcomes. Why? Well, for a start there is a general lack of consensus or even understanding of what integration is, and its aims and benefits. And the many systemic and relational barriers to achieving more integrated care that doctors experience on a day-to-day basis, for example ‘conflicting organisational priorities’, can’t help much either.

So what would be required to make the profession more confident that integration really could be the answer to many of the woes of the NHS? Our research also established that the two most important criteria for measuring the success of efforts to integrate services, from the perspective of individual doctors, were ‘improved clinical outcomes’ and ‘better patient experience’. ‘Cost savings’, it should be noted, did not even come close.

While a standalone topic in policy terms, in reality it is difficult and potentially unhelpful to separate integration from other drivers of service change, such as hospital reconfigurations and moving care into the community – and the mere mention of these policies usually sets hares running.

The next 18 or so months will see the NHS under mounting pressure. The financial settlement will become an even starker reality and consequently the need to address any unsustainable provider configurations will be all the more pressing. Clinical Commissioning Groups will be expected, somehow, to make it all work at the same time as finding their new commissioning feet.  

The BMA's new guide - Integrating Services without Structural Change - deconstructs the 'what and how' of integration, offering a practical approach that doesn't require the problems of the entire local health economy to be solved first.  For example, it describes common methods of integrating services 'virtually', such as multidisciplinary teams and joined-up care pathways, which can improve the way providers work together around the needs of patients.

But is any of it worth doing during this period of flux? Yes, because if we wait for things to calm down we could be waiting a while (or forever). Any activity that seeks to strengthen inter-professional and inter-organisational relationships and communication will serve the purpose of improving the quality and responsiveness of NHS services in the long-term.

And, whatever the commissioner and provider configurations of the day, it’s still the same doctors, nurses and other clinicians treating the same patients after all.

Sally Al-Zaidy, BMA senior policy analyst

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