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office functions are integrated,
e.g. integrated electronic
patient records. This can reduce
expenditure on staff, improve
efficiency and communication
and reduce duplication
i
Clinical integration: the provision
of a single coherent process
within and/or across health and
social care boundaries to provide
care through shared guidelines.
An example would be joint
primary and secondary care
prescribing and management
guidelines for COPD or asthma.
If we are to provide really
integrated care for people with
respiratory conditions, then some, if
not all of these elements will need to
be developed.
So, where to start? There are
already moves to provide more
integration. The future hospital
report (Future Hospital Commission,
2013) recognised the importance of
shifting care out of the acute setting
to provide a more outward-facing
role for hospitals, with specialists
working across hospitals and the
community setting.
More recently, The
Five Year
Forward View
(NHS England, 2014)
explains how the NHS needs to
change by tackling the root causes
community, secondary and
social care
i
Services are organisationally
distinct, i.e. GP practices are
generally businesses run by GPs,
while hospital and community
services are ‘owned’ by the NHS
i
Staff are employed by different
organisations with separate
health records and a lack
of integration of data and
information systems.
Integrated respiratory care will
not happen overnight. We need
to learn from the experiences
of the trail blazers described by
Robertson et al (2014) if we are to
be successful. There needs to be
trust and an understanding of each
others’ roles and perspectives and a
mutual respect in recognising how
different healthcare professionals
complement each other.
Knowledge needs to be shared to
enable staff to better diagnose and
treat patients, with the development
and implementation of care
pathways, while supporting patients
to develop self-management
strategies and skills.
It is accepted that changes in the
provision of care can take time and
that strong leadership is required,
with communication and negotiation
of ill-health, e.g. smoking; giving
patients more control over their
care; providing care that meets the
needs of the aging population; and
ultimately developing new models
that expand and strengthen
primary care.
It is also important to bear
in mind what we are hoping to
achieve so that ‘integrated care’
does not simply become the latest
health service trend to be forgotten
in the next wave of change. The
aim of integration is to improve
coordination of care, prevent ill-
health, and achieve greater value
for money.
But, as well as considering the
positives, we must acknowledge the
potential barriers:
i
As it stands, budgets are
separate and split into primary,
Having worked in respiratory care for many years at a local and
regional level, I am aware that there are widespread variations in care,
with underlying fragmentations in services, resulting in concomitant
adverse effects on morbidity and mortality. Worldwide trends in
healthcare reform advocate integrated working as the solution to
providing equitable high quality solutions to the problems of disjointed
care, poor outcomes, high level demand for services and a growing
elderly population — many with chronic conditions and comorbidities.
Integrated care appears to be a simple concept focusing on coordinating
care for people, especially between health and social care, but there are different approaches to and
definitions of the concept. In reality, attempting to improve services through reorganisation can be
difficult, often because the fragmented systems in place have encouraged ingrained inflexible practice,
with people reluctant to relinquish deep-rooted ways of working. This feature on integrated care is a
timely reminder of the issues and challenges ahead.
Jane Scullion,
respiratory nurse consultant, regional respiratory clinical lead, East Midlands
RESPIRATORY CARE MATTERS
i
6
RESPIRATORY CARE TODAY
2015,Vol 1, No 1
“
Knowledge needs
to be shared to enable staff
to better diagnose and treat
patients, with the develop-
ment and implementation of
care pathways, while sup-
porting patients to develop
self-management strategies
and skills.