Clinical update

Building Bridges, Breaking Barriers

An examination of the latest policy and what it means for healthcare professionals

Essential facts

Integrated care has been identified by the government and health and social care organisations as a vital step in responding to the increasing numbers of older people with complex needs, who are likely to receive care from several services in different locations. 

A report from the Care Quality Commission (CQC) highlights the difficulties older people face when they move between healthcare providers, despite the commitment to integrated services across England. It says substantial improvement is needed to prevent unnecessary hospital admissions and avoid confusion.

This is a pressing issue and will become even more so as the number of people aged 65 and older rises by 40% over the next 17 years to nearly 17 million.

Main arguments/findings

While the CQC found good practice in many integrated care initiatives, and observed considerable efforts from providers and commissioners to improve how services work together, it did not find many examples of integration working especially well. It reported large variations in care provision and in older people’s experiences and outcomes.

It was difficult to identify the most effective integrated care systems and there seems to be no ‘best way’ of integrating care. Instead, the onus falls on patients, their families or their carers to coordinate care.

The report also found:

  • Older people had multiple care plans due to the failure of professionals to share information. Professionals lack knowledge of how to write and review care plans.
  • Many organisational barriers to timely identification of older people at risk of deterioration or unplanned admission to hospital.
  • Successful joint working initiatives may often be short term or reliant on temporary funding and goodwill between different providers.
  • Monitoring and evaluation of initiatives is not done locally or is insufficient. 
  • Older people and their families are not given clear information about care coordination routinely. 

Recommendations

Health and social care leaders should build on the NHS Five Year Forward View vanguards and Sustainability and Transformation Plans to arrive at a shared understanding of what integrated care means in their local areas and work to deliver it. This involves the development of a shared language. Leaders should demonstrate ‘clear ownership and responsibility’ for integrated care locally.

Implications for nurses

One older person quoted in the report says: ‘Telling the same story again and again becomes draining and you end up just wanting to get out. How can a professional come to an appointment without some information?’ 

This comment underlines the importance of nurses and other professionals not relying on patients and families to carry information about their medical histories. Staff should be aware of data-sharing tools and must share information with other professionals, and older people and their families. They must also ensure that data are consistent. 

Older people’s nurses should understand priorities and pressures faced by colleagues in other sectors. Nurses working in discharge teams can focus on clear communication after the report highlighted inconsistent communication between hospital wards and discharge teams, and between hospital teams and social care and community-based teams. 

One example of good practice in integrated care is Connecting Care, led by NHS Wakefield Clinical Commissioning Group and Wakefield Council, which coordinates services for people with long‑term conditions and complex needs.

Expert comment

Cliff Kilgore, nurse consultant intermediate care at Dorset HealthCare University NHS Foundation Trust

‘The report is a reasonable attempt at reviewing the national picture of integration and, although it is limited by the small selection of mostly city areas, it gives a genuine picture of the problems experienced. 

‘Although there is a desire by many health and social care professionals to work together for the good of patients there are clear barriers to success. 

‘These are not new problems, but they are not easily resolved because they include different IT systems, separate budgets and separately commissioned services that sometimes inadvertently pit providers against each other to compete for the same work. 

‘There are pockets of good practice driven by passionate staff and  the success of integrated services will depend on encouraging innovation from these motivated professionals.’

 


Find out more

Building Bridges, Breaking Barriers: How Care is Integrated across Health and Social Care and the Impact on Older People Who Use Services, and their Families and Carers

National Institute for Health and Care Excellence (2015) Transition Between Inpatient Hospital Settings and Community or Care Home Settings for Adults with Social Care Needs  

National Voices, Age UK, UCL Partners (2014) I’m Still Me: A Narrative for Coordinated Support for Older People 

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