‘Turbocharged Integration’: how can we make this person centred?

By Andrew Reece

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On World Social Work Day Jeremy Hunt unveiled his seven pillars of social care reform, promising to ‘turbocharge’ the integration agenda. But will this really solve the social care crisis? Or does this simply speak to what appears to be the Department of Health (and social care)’s view[i] of social care as a handmaiden to Health?

Without wanting to dwell too long on Hunt’s poor analogy (lest we forget, a turbocharger takes hot gas from the backend of the system and uses this to pressurise the front end: lots of fun to be had comparing the engine to a hospital with that one) it might be useful to clarify what we understand by integration.

In Camden’s integrated Learning Disability Service we are trying to develop our understanding what integration means. At an away day to consider this is I asked a trick question: ‘what is integration?’ The team of mixed health and social care professionals, who have been ‘integrated’ for 21 years now, came up with a variety of system focused responses: professionals working together, organisations merging, pooled budgets, shared IT, were among the common elements of their thoughtful and considered suggestions.

However, I then suggested to them that this not the right question: it’s looking through the wrong end of the telescope. I suggested to them that the right question is: ‘what is integration for?’ Unless we can agree an answer to that question, a rush to ‘turbocharge’ directionless change and reorganisation could create more problems than it solves.

IPPR’s 2013 Paper ‘Whole Person Care’ looks through the right end of the telescope. By starting with the premise that people aren’t interested in the shape organisations, their governance or the KPIs. People who use seek our support are only really interested in how they experience the care and support they need from the state. Thus IPPR suggest that

Co-ordinating care around individuals is far more important than integrating structures. The focus should be on ‘hiding the wiring’ so that people experience seamless care, whether it is from a single provider or multiple organisations.

The aim of this blog, like at our away-day, is to kick off a conversation about ‘what integration is for’. I like to keep things simple, after all it’s much easier to co-produce solutions if everyone understands what we are trying to achieve through our shared endeavour. So my answer is that integration should aim to achieve 3 things:

  1. Improved outcomes for people who need care and support and their families
  2. An improved experience of interacting with the system for people who need care and support and their families
  3. Improved use of resources across the whole system

Neither should integration just be about the NHS and Local authorities. In our local Camden context, we are working with our commissioners to include our key local support providers as partners in that integration journey: there’s little to be gained by having Local Authority and NHS integration, if the front line services who deliver the day to day ‘hands on’ support think that our interactions with them are ‘patronising, officious and condescending’ (yes, that is what they told us!). Terry Bamford[ii] suggested over a decade ago that quality improvement in front line services arises when we see providers as strategic partners rather base our interactions with them on ‘contract monitoring’. Recent work from the Kings Fund[iii] has started to create an evidence base that backs up what they call this ‘system leadership’ approach. We hope that this partnering approach will

  • allow us all to benefit from their insight and expertise as their staff spend more time with the people they support than we do
  • support us to share responsibility when things go wrong and work together to learn from this
  • share and celebrate success and learn from that too!

Conversely, ‘disintegration’ becomes any activity that inhibits these aims, or any activity carried out in isolation or with a narrow focus on ‘my KPIs’ rather than system wide improvement. My challenge to readers, whatever part of the system they sit in, is to find the right end of their own or their organisation’s telescope and work to coproduce a local agreement as to what integration is for, and use that to drive the ‘shared endeavour’ that could lead to whole person care across their the whole of their local system.

Answers on an Easy Read postcard please!

[i] See Caroline Dinenage MP, Minister of State for Social Care, introduction to the Chief Social Worker’s Annual Report 2017-18

[ii] Bamford, Terry (2001) Commissioning and Purchasing, Psychology Press, London

[iii] Enhanced health in care homes: learning from experiences so far

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