How can different parts of the health service work together more effectively?
We investigated how primary and community care can be better integrated with other health and social care services.
Patients at the centre: integrating primary and community care
High service demand, insufficient preventative care, an aging population, and workforce shortages are challenging the long-term sustainability of the NHS. Integration – different services working together to coordinate care – can help contribute to solving these problems.
If services are coordinated and planned effectively, then care could be more preventative, as well as curative. This could improve long-term public health and reduce demand on the NHS. When services work well together, resources are used more efficiently, meaning that a better service could be provided with the same funding.
Integration gives healthcare workers greater responsibility and ownership for the services they provide. This can improve morale and leadership, and therefore retention.
Most importantly, when services are designed around a patient’s needs, their journey through the healthcare system, from diagnosis to recovery, will be smoother with care of a higher quality.
However, there are major barriers preventing the integration of primary and community care with other services.
The current structures which run the health service, and the way in which support services are contracted and funded, do not do enough to incentivise them to work together. It is often difficult to transfer patient data between services, which makes it difficult for clinicians to coordinate a patient’s care.
Health care workers often lack the training and experience needed to work with other disciplines to treat patients more cohesively.
Here are our four key findings on the barriers to integration.
1. Structures and organisation
Structures running the health service must be optimised
Running health services is not just the responsibility of the NHS. At a local level, primary and community care, hospitals, local authorities, and voluntary organisations, all deliver health and social care services.
This care needs to be well integrated, meaning that service leaders need to work closely together. We found that the effectiveness of Integrated Care Systems (ICSs) need to be properly understood before any large-scale reforms to the health service are introduced.
Nonetheless, there are things which the Government can do now to ensure that ICSs are optimised to coordinate healthcare more effectively.
Elected local government officials should be allowed to chair the boards which run ICSs. The Government should give an update on its plan for single accountable officers to run local health services. The Government should set up a review of ICSs after their third anniversary.
2. Contracts and funding
The way that healthcare services are contracted and funded needs to change
Funding for health services is currently too concentrated on reactive hospital care, rather than the more preventative care that takes place in the community.
Greater preventative care could be done in the community if the funding and contracting of services is reformed. Better and more preventative care can be provided if clinicians from different services can work together.
However, they are paid from different pots of money and are accountable to different managers. This makes integrating services difficult.
Schemes like the Better Care Fund (BCF) provide joint funding, but this does not go far enough: services need to be integrated at a very local level. Therefore, their funding also needs to be integrated.
Primary and community care contracts should be reformed, so that services receive more money for inter-disciplinary work and training, improving long-term health outcomes.
3. Data sharing
Sharing data between services needs to be made much easier
Effective data collection, sharing, and analysis is essential for integrated working in the health service. Patients currently experience poorer care because of problems with data sharing.
For example, patients are repeatedly asked for details of their condition from different clinicians, while their referrals from primary to hospital care are lost.
We were told that the problem was so concerning in optometry that “Individuals are losing their sight because their records get lost, and their referrals do not get expedited.”
The Government should publish high-level guidance that clarifies how data and privacy laws apply to patient health information. It should also set out guidance to standardise how patient data is collected, recorded, and controlled, to make it easier to share data between services.
4. Workforce and training
The primary, community and social care workforces need more high-quality training on integration
The NHS’s biggest asset is its workforce, but healthcare workers are not sufficiently trained in integrated working with other clinical disciplines. This makes it harder for services to work together to provide holistic care to patients.
There should be a general shift towards patients seeking treatment at the earliest opportunity, ideally from non-hospital services.
Primary and community clinicians are trained to a very high standard and are essential at identifying and treating conditions before they reach an acute level.
Giving these sectors more responsibility within the health service will help shift care from being curative to preventative.
Training time within primary, community, and social care should be funded and protected. More community disciplines should be given independent prescribing and referral rights. Opportunities for job rotations should be plentiful to enable clinicians to gain broader experience and skills, especially among social care workers.
What happens next?
We have made our recommendations to the Government and it now has two months to respond to our report.
Read the full report on our website.
Find out more about our inquiry and our committee.
Our committee is a special inquiry committee for 2023.
Follow the committee @LordsCareCom
Cover image credit: DC Studio - stock.adobe.com
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