Nuffield Trust calls for integrated care

A single patient record and single joint needs assessment process are among the goals of five health economies working to deliver more integrated care, according to a report from the Nuffield Trust.

The health policy charity looked at five areas in England – Torbay, Nottingham, Redbridge, Trafford and Cumbria – where local clinicians and managers are working together to break down the barriers between different health professionals and services.

The trust’s report, ‘Removing the policy barriers to integrated care in England’, says finding ways of drawing together clinical data from different parts of the local health system is a common feature of the work taking place.

It says it is a key concern for Trafford, Redbridge, Cumbria and Torbay. Each area is aiming to develop a single patient record.

The report says that the use of EMIS Web in Cumbria is a “vivid example” of how clinicians are working together to use information as a core part of managing the care and health of the local population.

The report adds: “Similarly, in Torbay progress has been made in the development of an integrated health and social care record by building on existing systems, rather than waiting for the National Programme [for IT in the NHS] to deliver.”

The report concludes that the reforms outlined in the ‘Equity and excellence: Liberating the NHS’ white paper – and particularly the shift to give commissioning responsibility to GPs – have the potential to deliver more seamless care to patients.

However, it says the five case studies indicate that there are a number of policy barriers that will need to be overcome. These include encouraging collaboration as well as competition among health and social care providers and greater pooling of resources with social care.

Dr Judith Smith, Nuffield Trust head of policy, said the health service would have to do things fundamentally differently if it was to deliver the productivity gain that it needs to make over the next four years.

“While the evidence base is still mixed, encouraging integration between providers of care is the most rational way forward to reduce fragmented care, the avoidable ill health it produces and to improve efficiency," she said.

Fellow report co-author Professor Chris Ham, the chief executive of The King’s Fund, said: "Patients expect health and social care providers to work together to deliver high quality care, but this is often not the case.

"The government must do more to break down barriers to integration through smarter regulation and aligned incentives. Hospital specialists should work alongside GPs in delivering care closer to home."

The report says that in Redbridge the health economy has been divided into five localities or polysystems, each covering a population of 50,000.

The area has financial deficits of £140m, which are growing, and needs to decommission 20% of outpatient activity and prevent 35% of admissions from people with long term conditions.

Budgets are being devolved to federations of GP practices and the report says information and information technology will drive change at all levels. There is a particular emphasis on risk stratification of the population and identification of those most at risk and in need of proactive care.

The report says that in Trafford, NHS organisations have come together to develop an integrated health system across primary, community and hospital care.

The Trafford approach focuses on the introduction of innovative models of care using new technologies.

Community-based physicians have been appointed to nine local ‘vanguard’ practices with the aim of focusing on people identified at high risk of hospital admission, overseeing the implementation of telehealth and implementing new models of care.