Health Service Focus

Transforming services to make way for integrated care

Kate Ravenscroft, policy manager at the NHS Confederation, describes the results of a recent survey conducted in partnership with ADASS on the barriers to and enablers of integrated care.

A poll of adult social care directors and local health service commissioners shows a widespread feeling that integrated care must and will happen – but that there are still big barriers along the way.

The top three barriers mentioned by most people were data and IT systems; organisational complexity; and payment mechanisms.

By contrast, when asked what has most helped the journey to integrated care, the top three answers were leadership, commitment from the top, and joint planning / strategy.

NHS Confederation policy manager Kate Ravenscroft, who led on the work, told NHE: “We’ve been very conscious for some time that successful efforts at integrating care and integrated commissioning will require good local leadership; you can’t mandate it from the centre. [The survey] really does underpin, with some numbers, what we and ADASS have been picking up from our members.

“Our sense is that it has tended to be about leadership from within the organisation. A few years ago, we were finding that you tended to need an almost unusual type of leader to make integration work, because of the number of barriers they’d need to overcome. Often, they’d have to be quite an extraordinary person.”

The new survey, conducted by the NHS Confederation and the Association of Directors of Adult Social Services (ADASS) just as the NHS transitional reforms were taking place in April, follows up a previous snapshot of opinion on the subject done in 2010.

Comparing the two datasets suggest there have been some real improvements since then in relationships between organisations, in having joint strategies, good local leadership and on joint commissioning.

But organisational complexity has become a bigger problem, and ‘different cultures’ was mentioned more often as a hindrance too. Performance regimes, a big barrier in 2010, are no longer seen as such a problem.

Asked whether the findings rang true for her, based on the conversations she has with people in this sector, Ravenscroft told us: “There wasn’t a lot in it that surprised me, in the sense that a lot of the things the survey covered, in terms of the barriers to integration, the enablers and the benefits it can bring, backed up things we knew anecdotally that people have been saying. It’s useful to have the numbers to back up that feeling that there is a groundswell of opinion across the health and social care sector that some of these things definitely are important.

“The sense we get across the piece is that people do understand that integrated care needs to progress rapidly and scale up, and there’s a great deal of commitment to that. The survey findings reflect that commitment, but also some optimism that people are starting to see how they can make things work in their areas. It was interesting, for example, that there’s a large degree of optimism that Health & Wellbeing Boards will help.”

The fact that IT and data systems was mentioned by most people didn’t necessarily mean it was actually the biggest barrier, Ravenscroft said – just that it was a persistent problem in many areas.

The poll indicates that the biggest driver for integration continues to be patient and care user benefit – but that when services are integrated, money can be saved as well.

More than half of respondents to the survey reported a reduction in delayed discharges in areas with integrated services, and 40% mentioned a positive impact on unplanned emergency hospital admissions.

ADASS president Sandie Keene said: “This early evidence of closer work with the health service is entirely welcome. As it develops it will have a growing positive impact in accelerating the changes we are making and acknowledging the role of social care in the delivery of effective health services, particularly for those people with long term conditions.

“Overall the survey contains encouraging and positive early signs that the move towards integration is gathering pace and support where it matters most – in localities and across all levels of care staff.”

NHS Confederation director of policy Dr Johnny Marshall added:

“With everything going on in health and social care services over the past few months, there was a risk local leaders could have adopted a ‘hunker down’ mentality. What snapshot surveys like this demonstrate is the resilience which clinicians, practitioners and managers possess in order to continue to focus on patients and service users. The drive to develop integrated services around users transcends organisational upheaval and the day-to-day difficulties of mismatched inherited computer systems.”