Delivering Integrated Care: Set the User Free
“Our view at the Fund is that priority now needs to be given to putting in place policies to support integrated care, and offering practical help to enable providers and commissioners to take integrated care forward at scale and pace.” – Chris Ham, September 2013
We agree that Health and Social care should be more integrated and easier to navigate.
But we have a different perspective on how it can be delivered. It is not the same as the Kings Fund or Chris Ham. This is primarily because he and many of his peer group in professional bodies are tasked with; and clearly passionate about the institutional response. And if you are looking for an institutional response to the Integrated Care question, then the Kings Fund can go some way to giving you the answer.
The problem though for delivering Integrated Care is that the policy makers and service providers are tasked with coming up with the solution and given the wrong questions to answer. The questions of the think tanks and the service providers are “what things need to change for us to be able to deliver integrated care”.
It is a big problem that they are asking and therefore answering the wrong set of questions. Policy, structural changes, regulation, pilot sites will never work. Successful businesses in the Social era (not social media era) would say that the Gorilla responses of the Big Institutions will never deliver integrated care. It might be structurally integrated through merger or joint venture if OFT allows it but it will never deliver integrated care.
Here is the reason why we need to ask a different question:
My daughter is 11. She has severe neurological disability and relies on Health, Social and Education systems to provide a range of care packages for her. She is a complex case and she is vulnerable.
We as a family access the following services:
We have for 11 years built up an integrated service for our daughter, and we have done so by this simple technique:
We have taken our time to understand the system, built relationships with providers, navigated the bureaucracy needs and we manage the professional services provided against our daughter’s requirements. Our role as an advocate and navigator in partnership with our GP and Paediatric Specialists has ensured the services we provide to our daughter are integrated. We advise our GP on the complexity of the system and she plays a significant role in advocating for us where necessary.
We take responsibility for the integrated experience and we co-ordinate our daughter’s care packages with professional support.
If we allowed the system to try and provide the integrated package without our input-it would fail. Not because it doesn’t want to be integrated as a system. It will fail because the best way of ensuring integrated care is to hand back accountability and engage as a system with the user.
Our daughter cannot speak for herself. We advocate on her behalf and through committing to relationships with providers, we can ensure her needs are met in an integrated and seamless way.
We have taken responsibility and we have been given responsibility back.
So if Integrated Care is the answer what is the question?
How can we ensure that users better understand and take control of their care in conjunction with their local advocate and their family and friends?
If we decentralised healthcare spending tomorrow and gave everyone a personal budget. What tools could we provide to patients and their advocates that enabled them to access the right services at the right time?
In our view, policies and service providers cannot deliver integrated care as a centralised and institutional response. It is tempting to believe that policy and structural intervention can deliver integration in both form and function. Social media has more of a chance than government policy.
The questions we have asked are about our ability to think about empowering the user and seeing the user as not just somebody or something at the end of the health and social care value chain.
The temptation for many policy makers and professional bodies is to fall into the Gorilla trap that “we know best” “we can design the integrated system for you”… “we are the professionals after all”.
Policies and Commissioners and Providers cannot deliver integrated care.
We did and you as a user, advocate and relative can.