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FEB 20/2014

Integrated care: the new watchword in NHS planning

One of the key focuses for the Department of Health over the coming years is finding new ways of empowering NHS staff to improve on the high standard of care that they currently provide.

It is widely recognised that the UK's medical workforce is among the finest in the world - but often, cultural and organisational barriers can result in inefficiencies, miscommunication and oversights that can impact on patient outcomes.

Clearly, this is a state of affairs that nobody wants to see continue, so the government is making a concerted effort improve the integration and coordination of NHS care in order to ensure all patients are treated as respectfully, responsively and effectively as possible.

This drive is likely to have a number of knock-on effects for staffing levels, management approaches and professional responsibilities, meaning doctors and nurses would do well to educate themselves on the implications of the reforms in advance.

The case for greater integration
The need for greater integration was outlined by health secretary Jeremy Hunt at a recent speech at Guy's and St Thomas' Hospital, during which he highlighted a number of reports and cases that demonstrate the pitfalls of fragmented care structures.

Often, patients find themselves frustrated by being passed around different departments and divisions of care, receiving mixed messages and contradictory advice from each person they speak to. He cited a recent Royal College of Physicians survey that showed many doctors are sceptical about their hospital's ability to deliver continuity of care, with one member of staff describing care provision as "episodic", while another likened it to a "series of brief encounters".

This lack of teamwork has a number of negative consequences. It can mean patients feel their doctors do not understand their individual needs; it can result in certain divisions becoming oversubscribed while others are underused; it can also exacerbate regional variations in care quality. All of this can contribute to poorer outcomes for patients.

A change in organisational culture
As such, influential thinktanks the King's Fund and the Nuffield Trust have called for integrated care to become the top NHS priority for the next decade, a challenge that the Department of Health seems to have accepted.

Its recent change to the GP contract will introduce a new setup that will give GPs personal responsibility for coordinating care across multiple services for individual patients; meanwhile efforts are also being made to put the names of responsible doctors above hospital beds, to ensure patients can form long-term relationships with their carers.

This comes as part of wider plans to ensure all parts of the NHS communicate more openly, making sure patient details are properly shared between professionals in different specialisms, and making greater use of all sectors of the healthcare system - a move that could see pharmacists, dentists, physiotherapists and podiatrists given a more central role in care provision.

Other steps include facilitating data sharing through the implementation of modern IT solutions, rolling out seven-day services more widely, accelerating patient transfer and referral processes, and examining ways of bringing greater flexibility to shift patterns. 

The benefits of integration
Making these changes to NHS service models has the potential to bring all sorts of benefits. More career opportunities will open up in currently undersubscribed sectors, and professionals be more informed, more empowered and will have greater flexibility to provide tailored treatment plans for each of their patients.

Meanwhile, service users will be able to rest assured that their needs are fully understood and are being catered for by an entire team of medical staff. They will also be able to exercise greater control over their own treatment strategy, choosing between a number of viable therapy options according to their personal needs and preferences.

As such, it is expected that the drive for greater integration of care - if successful - could be one of the most positive changes in NHS planning for many years.

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