The number of people with complex health and care needs is rising. Around 1.9 million people in England already have three or more health conditions and by 2018 this is expected to increase to 2.9 million. Care for people with one or more long-term conditions is complex and each individual needs joined-up, comprehensive care tailored to their personal needs and preferences.
Patients and policy makers have both called for care to be integrated and delivered closer to home. However, the transition and development of services requires a movement between secondary and primary care, with the associated necessity of alignment of funding flow and incentives to change. This can be a challenge, resulting in some people favouring the status quo.
Integrated care brings together the different groups involved in patient care so that, from the patient’s perspective, the services delivered are consistent and coordinated. Too often, providers focus on single episodes of treatment, rather than the patient’s overall wellbeing. There are some key requirements to this “one-stop shop” approach. Two that are absolutely necessary are patient involvement in the planning and design of the services and integrated IT systems.
Patient involvement is essential, there is evidence that patients who are actively involved in their own healthcare, including in the decision-making process, have increased adherence, better clinical outcomes, and greater patient satisfaction, and increasing these factors could potentially reduce healthcare and societal costs.
Self-care is a vital part of integrated care and people are being encouraged to take a greater part in their own care with more responsibility for their health and wellbeing. Self-monitoring of your INR for those taking warfarin is a good example of self-care, and there are excellent examples of where digital technology is being used to allow people to self-test and report directly to a nurse or doctor using an app. Thus freeing up clinic time for those more complicated cases.
Integrated IT systems have always been a challenge for the NHS and NHS England is currently undertaking a review of computer systems across the NHS. If you look at industry in the private sector you can see that they increasingly use digital technology to integrate and interface with their customers. We must follow that example and use technology to help close the gap between primary and secondary care by creating integrated and seamless pathways of care. This gap is often the barrier that prevents us from being able to deliver the personalised and coordinated health services that people need and want.
Technology is there to help us we must learn to embrace it.