Integration. It's a frequently used word, but one that is often misunderstood. It has multiple definitions – over 175 at the last count – which can understandably lead to confusion about what we mean by the term and how we can deliver real change that lasts.
It’s not a new concept – politicians, policy makers and users of health and care have been calling for better integration for many decades, and local health communities have been trying out different approaches for years. There have been no end of initiatives which have sought to prove the benefit of integration, and even where there has been positive evaluation, adoption across the country hasn't followed.
Patients and users of care have long been saying that the lack of integration is a major frustration for them: “We are sick of falling through gaps… the organisational barriers that delay or prevent access to care.” This statement is strongly indicative that something needs to change in how we think about integration and make it a reality.
A first step is a common definition – based on what people say they want. That’s why PHE was one of the national partners that signed up to Integrated Care and Support: Our Shared Commitment. Within this framework was an agreed definition – developed by National Voices with patients, users and carers – that, for the first time, set out what integration means to people: “I can plan my care with people who work together to understand me and my carers, allow me control, and bring together services to achieve the outcomes important to me.”
That definition has suddenly has made integration sound simple, and really importantly has reminded us all that integration should be about the lives and experience of people who need health and care, rather than being about organisations and structures.
With a clear definition, partners across the system can now – at both national and local levels – work together to find the solutions that work for local areas. The national partners have signed up to a programme of work to unlock the barriers which are preventing local areas from delivering the innovations they want to see.
Within this programme of work, the national partners have committed to supporting integration ‘pioneers’ – local areas trying out innovative change that will make real difference to improving how care is co-ordinated. It was a real personal privilege to be on the selection panel for the pioneers on behalf of PHE, to get to see first hand the passion and commitment to change for the better in local areas, and for me to see local Directors of Public Health, such as Amanda Healy at South Tyneside, playing such a central role so early into transition was really encouraging. The 14 integration pioneers were announced earlier this month and I am looking forwarding to meeting all 14 areas with the national partners next month to agree how we can work together to accelerate and share learning. PHE will support the pioneers as they implement their innovative approaches and evaluate their impact, and we look forward to working with them and supporting the things that they would like to do.
Alongside the pioneers, all local areas will need to make step change in how they think about integration, with the Integration Transformation Fund as a key driver. We understand that the leadership role that local government is embracing to improve the public’s health has a key part to play in successful integration to drive health and well-being, other than to only manage acute sickness.
For an individual to be truly in control of their care, all their needs as a person need to be assessed and they also need information and support to make informed choices. They also need to feel included in their local community so that they can actively contribute as well as benefit from the network. All these elements are reflected in the Making It Real “I” statements, developed by the Think Local Act Personal partnership.
So, what does good integrated public health look like? All successful pioneers demonstrated a track record and capacity to deliver integrated services. I was impressed by South Tyneside’s focus on social prescribing and volunteering, as well as Barnsley’s approach to building stronger families and communities. There will be much we can all learn from the pioneers – and other innovative approaches up and down the country – about what works. This is why we are currently working with partners to share innovative and inspiring example of integration in public health.
My vision is that all areas will develop integrated approaches that places the person at the heart– that thinks about the public’s health alongside the management of sickness, so that service users really are in control of their life and health.