I’ve lost count of the number of different definitions that have been given to integrated care.
In England, the geographically determined initial sustainability and transformation plans have been renamed ‘partnerships’ and those that have been designated as the most advanced are now called Integrated Care Systems (ICSs).
While we are on acronym overload, the commentary and portrayal of integrated care often remains within the services and institutions attempting to deliver this.
Possibly the two most common aspirations for care service integration have been that between health and social care, and that, often called vertical integration, in health services between primary and secondary care. The narrative has been exhaustive, the ambition laudable, but the delivery often left on the ‘too hard to implement’ pile.
In England a government department has now been restructured to become the Department of Health and Social Care to support better integration of health and social care.
Although organisational memory in the NHS is unhelpfully and sometimes harmfully short, many of a certain age will remember when we had a fairly functional Department of Health and Social Services (DHSS) – but was split in two to improve efficiency and effectiveness of care resources in 1988.
Following our creation of an international faculty, led by the National Association of Primary Care (UK) and the Patient Centred Primary Care Collaborative (US), the first publication to try and demystify accountable care was published in September 2017 – Providing Accountable Care: comparing the delivery of primary care in the UK and the USA through accountable care systems and organisations
As a follow up, the Faculty is coming together again in Dublin for two days to produce a similar publication on integrated care services. The publication will be available to international health care services in the summer.
There is nothing new in the ambition to provide more integrated care systems. However, defining integration maybe best thought as a concept defined by the perspective of those aiming to create such a system of care. Possibly, the former World Health Organisation (WHO) definition of integrated care should always be used as the context which defines integration as the bringing together of inputs, delivery, management and organisation of services relating to diagnosis, treatment, care, rehabilitation and health promotion.
Integration is about bringing together physical and mental health, health and care, and health and wellbeing. It is also a way of improving services including access, quality, patient satisfaction and efficiency.
If our next paper can strengthen and describe this in more detail, in the context of the experience of the faculty members, then I hope it will be a valuable publication.
Dr James Kingsland OBE
President, National Association of Primary Care (NAPC)
