Developing the Integration Standard further: a framework for action

The Department of Health’s draft Integration Standard study confirms that the journey towards integration is ongoing and evolving.

Building on a national consensus for integration, the development of the Integration Standard can prioritise and accelerate the system changes required to achieve the ambition, but concerted efforts are required nationally, locally and at the point of care.

We suggest conceptually breaking down metrics into national and local objectives.

National challenges

The national challenges are appropriate for central government agencies and NHS national bodies (e.g. NHS England, NHS Improvement, Care Quality Commission) to lead and resolve. These actions would help remove the policy and contextual barriers to integration related to financing, regulation, system governance and accountabilities, including:

Local challenges

The local challenges are best defined nationally but applied locally. They specifically reflect the capabilities of partners to deliver integration, and in many respects they are consistent with the proposed Standard. They recognise that local partners may need guidance and practical support in tackling local barriers to change.

The refinement to the proposed Standard should include effective indicators for measuring:

Frontline challenges

The frontline challenges are best understood as measuring the actual delivery of integrated care. They apply primarily to the workers responsible for care, and focus on the point of care, the management of care and especially individuals’ experience of care.

Key issues are: