On a journey towards better integrated health and social care

Featured article - 30 October 2017
By Ewan King, SCIE director of business development and delivery

Head-shot of the author, Ewan King, SCIE director of business development and delivery

This article first appeared on the Better Care Exchange.

People often describe the integration of health and social care as a journey; a long and, sometimes, bumpy road towards a destination of better-coordinated and person-centred care. Whilst over the last 20 years or so some progress has definitely been made on the development of integrated intermediate care, for instance, progress has often been frustratingly slow. As the National Audit Office concluded last year, 'Nearly 20 years of initiatives to join up health and social care by successive governments have not led to system-wide integrated services.'

But integration, while undoubtedly complex and deeply challenging to achieve, remains universally seen as the right thing to do. Commitments from the Government, NHS and local government to this, as recent announcements have made clear, remains undiminished. So how do we get there?

Useful milestones required

Through research we have conducted for the Department of Health (DH), people have consistently told us that there is something which would really help - some kind of framework, developed with the field, which helps people focus on what good integration looks like. Returning to that theme of integration as a journey, they want to know more about where they are going, and what milestones they will have to pass on their way there.

In this space, much good work has been done; Our Shared Commitment and ‘I statements’ are, for example, still widely used to guide systems-wide planning and they clearly describe what the end result should be like from the critical perspective of people who use services. But less is known about some of the key building blocks of good integration, that reflect some of the most recent changes to policy and changes to the system. One example is the role of personalised commissioning and evidence-based interventions linked to the new models of care.

Thinking through the logic

The Social Care Institute for Excellence (SCIE) is in the process of developing something that might serve this purpose. In April 2016, we were commissioned by DH to consult on their Integration Standard, which aimed to describe what integrated care looks like through seven core features. This Standard, as a result of feedback and wider engagement with the sector, was then transformed into an integrated logic model, a kind of visual chart which shows how key enablers and components of integration can produce better outcomes for service users and the wider system.

The framework will serve two purposes: it will provide a conceptual framework to help local areas assess what they need to do to develop integrated care; and it will link to a planned wider integration scorecard, which is a set of metrics for measuring progress towards integration.

Developed through extensive research with practitioners and service users, including through two large events in Manchester and London in September 2017, people have told us that the logic model will be a helpful tool for looking at the whole system and for thinking through priorities and actions. Whilst the eventual list of metrics that sits underneath it is yet to be determined, the logic model is already being used by the Care Quality Commission and several local areas, to inform their work on integration.

This phase of the work - finalising the logic model and integration scorecard - comes to a close soon, and we hope further news on the logic model and its use will be shared shortly. In the meantime, the journey continues and with the logic model as a guide on the destination, the road should be a little smoother.

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