Closing in on integrated care

With seamless, personalised care increasingly part of the NHS agenda, here Anna Bokobza, community independence service programme director, talks about our vision for integrated care in North West London and our early service successes.

For many years, integrated care has been seen as the NHS’s holy grail – providing high quality care, tailored to the individual, seamlessly and efficiently. It’s a key element of NHS England’s Five year forward view, setting out how the NHS needs to change to meet future needs. But are we any closer to delivering truly integrated care, especially here in north west London?

Well, we definitely have a clear vision for integrated care in our patch, developed through collaboration between health professionals, patients and the public, led by our eight local clinical commission groups. The north west London whole systems integrated care initiative, established in 2013 and involving 31 health and social care organisations plus lay partners, is committed to achieving ‘better co-ordinated care and support, empowering people to maintain independence and lead full lives as active participants in their community.’

The collaboration has established some fantastic foundations, addressing tricky issues around shared outcomes, provider networks, and how commissioning, finances and informatics would work best in a truly integrated system.

Our Trust is also involved in a growing number of projects enabling and supporting better integration – bringing together different types of healthcare (vertical integration), linking health and social care (horizontal integration), delivering ‘hospital’ care in community settings (outreach), and facilitating individuals to take a more active role in their own health and health care (holistic care).

One of our first integrated care developments, back in 2012, was ‘itchy, sneezy, wheezy’. This is an allergy service for children where hospital doctors and GPs work together to help families proactively manage children’s eczema, asthma and hay fever. Over the time of the service, we have seen a 20 per cent reduction in the number of children attending our A&E departments with asthma.

The ‘connecting care for children’ service – or CC4C – followed, and now runs clinics in the community involving hospital paediatricians, GPs and families to provide integrated and tailored health care for children with a wide range of issues, helping them avoid unnecessary hospital admissions.

This year, we became lead provider for the community independence service for three of our boroughs, a game changer in terms of local integrated care planning. We work with the boroughs’ adult social care services as well as a wide range of primary, community, mental health and other acute health providers to enable frail and vulnerable people to be as healthy as possible, in their own homes wherever possible.

For example, the service’s rapid response team for Hammersmith and Fulham meets every morning to review 20 or so frail, local residents most in need of urgent health and social care. The team includes rapid response nurses and community therapists from Central London Community Healthcare NHS Trust, a local GP, a geriatrician from Imperial College Healthcare and social workers from Hammersmith and Fulham council.

One elderly man reviewed at a recent meeting had diabetes, a heart condition, leg ulcers and dementia. He wasn’t eating or taking his medication, which put him at risk of diabetic coma and stroke. He was estranged from his family, couldn’t manage his own personal care and was living in unsuitable accommodation. The community independence service helped co-ordinate all of the health and social care needed to support this man’s wide ranging health problems and to address his housing and family issues. The team found a way to support him as a person, not just as a patient or a client. And they did it quickly, efficiently and effectively.

The Trust is also leading on another collaborative project across north west London, the care information exchange. This is a key development, enabling clinicians and patients to share and discuss health and health care information online in real-time, with patients controlling access to their own data.

With solid foundations and a growing portfolio of joined-up services, it feels as if the time is approaching to take integrated care to a new level – making it business as usual for many more people. We are looking seriously at accountable care models, considering how we might work with partner organisations to meet a population’s total health needs, working with a ‘capitated’ budget – a fixed amount of money, per person, per year. We’re having good discussions with potential partners, and with local commissioners who are already committed to ensuring genuinely integrated care, at scale.

So, while we might not quite have our hands on the holy grail of integrated care, it does now seem to be within reach. And probably not a moment too soon –it’s difficult to see how else the NHS can continue to provide high quality care, sustainably.

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