The King’s Fund Integrated Care Summit 2014, co-sponsored by PPL, is fast approaching. In the run up to the event, Principal Consultant Alice Hopkinson explores what integrated care means for provider organisations and their member professionals, drawing on insight from James Reilly, Chief Executive at Central London Community Healthcare, at a recent training session for the North West London Lay Partners Advisory Group. The event was part of a programme of development sessions being run for lay partners by health and social care system leaders. The series includes a specific focus on developing political and tactical nous when engaging in whole system change, in response to direct request for support in this area from the lay partners themselves.
Clinical colleagues can often be perceived as a “confederation of warring tribes”, explains James. So how can we understand and influence the motivations and attitude of provider organisations (and the professionals within them) about a change as potentially disruptive as integrated care?
In James’ experience, professionals approach service change with three questions at the forefront of their mind:
- Does it go with the grain of my values?
- Can I see how my patients will be better (or worse) off?
- What is it going to do to my job (both in terms of autonomy and income)?
It can be hard to achieve a consensus, especially when there are significant “losses” (both perceived and real) on the table. When considering the attitude of professionals as a collective, understanding the role of the Royal Colleges is important: these are powerful institutions, but they exist in siloes and the nature of their structure doesn’t lend them towards collaborative effort.
Faced with the potential impact of shifting activity and care settings, provider organisations are thinking about whether they can maintain a size which attracts new students, and allows them to continue to deal effectively with a whole cohort of patients whilst maintaining the ability to specialise. The status quo is underpinned by a strongly forged operating model and there is the potential for real losses if it is unpicked, which is understandably a big threat to both health and social care providers.
In light of this, it is helpful to examine examples where, against all the odds, integration has happened before successfully, and to consider:
- Where did it work (some examples include the Cancer Collaborative, trauma, stroke services etc.);
- What were the steps taken; and
- How were the knotty issues dealt with.
The tie to a building is often a key driver for professionals in addition to their attachment to the patients themselves. One way to challenge this is to draw a parallel between the current approach to both NHS and private patient lists. For private patients, professionals are happy to work in different settings, and recognise that doing so does not put patient outcomes at risk. The bottom line is that form must follow function: and as the function adapts to better meet the needs of the patient, so must the form. Organisational differences will always be trumped by an argument that supports “the right thing to do for the local resident”.
James emphasises that the power of lay partners lies in their ability to reinforce to system leaders so that at the end of the day “we get it right for Mrs Smith, the patient and their carer”; and that for professionals working with Mrs Smith “we make it easier for them to do the right thing”. These are two of the key principles that drive progress in integrated and collaborative working.
Professionals need to be supported to adapt successfully in a new environment. In the same way that form must follow function, training should follow the development of a new service and the two should continue to evolve hand in hand.
For successful integration, GP engagement is critical. The recent boost in level of engagement from GPs and willingness to see themselves as part of the whole system is deeply encouraging. Provider organisations can support this by acknowledging that GPs are in the unique position of never losing responsibility for the patient throughout the process of care delivery across numerous settings and, as such, delegating weighted power to them in decision making – this will counteract the risk of GPs feeling disenfranchised and cut out of the change process.
Achieving integrated care will require give and take from all provider organisations and professionals. One key question to pose is “what is it that you will have to do differently in order to get other people in the system to do things differently?” In this way, change in the way that services are provided can be collectively owned and driven by those responsible for providing care.
Integrating Care's expert advisors will be participating in the King’s Fund Integrated Care summit 2014 on October 14th as part of a breakfast workshop on ‘Ten things every provider needs to know about integration’. To find out more and book your place to attend visit: http://ow.ly/BvlY9