Delivering integrated care should have the same priority as reducing waiting times, two health think tanks have claimed.

A joint report, by the the King’s Fund and the Nuffield Trust, argues that integrated care - which aims to coordinate care more effectively around the needs of patients - is essential to meet the needs of the ageing population and transform the way care is provided to people with long term conditions.

The Department of Health can create an environment in which integrated care can flourish, the report says, and it is less about extra spending and more about removing rigidities in the system and encouraging creativity.

The report follows the Prime Minister’s pledge earlier this year to make integrated care one of his five key priorities for the NHS and the NHS Future Forum’s call to ‘move beyond arguing for integration to making it happen’. The think tanks were subsequently approached by the Department of Health to feed in ideas for a national strategy on integrated care.

The report argues that integrated care offers an opportunity to improve services for those who need them most and help deliver the productivity improvements on which the future of the NHS depends. It sets out a number of recommendations designed to embed integrated care across the health and social care systems over the next five to ten years.

These include:

- A clear, ambitious and measurable goal to improve the experience of patients needing coordinated care, to be delivered by a defined date.

- Enhanced patient guarantees including an entitlement to an agreed care plan and a named case manager responsible for coordinating care.

- Reforms to financial incentives so that NHS payment systems reward good outcomes for patients rather than encouraging admissions to hospitals.

- Clear guidance on how competition will operate in the NHS to avoid perceptions that competition rules are a barrier to delivering integrated care.

- A programme of organisational development to support NHS organisations and local authorities to make change happen.

The report calls on the Department of Health to articulate a clear and compelling case for change and create an environment in which NHS organisations and local authorities can deliver integrated care at scale and pace. This, it argues, is essential to overcome a ‘permission-based’ management culture in the NHS that often discourages innovation and risk.

Chris Ham, chief executive of the King’s Fund, said: “Integrated care can be delivered without further legislative change or structural upheaval and would be embraced by the professions and NHS staff. It is time to move from pockets of good practice to ensure it is a must do priority and make it the core business of everyone involved in health and social care.”

In a speech on 7 June 2011, the Prime Minister said “integration is really important to our vision of the NHS” and made integrated care one of his five NHS ‘guarantees’.

The NHS Future Forum published its report following the listening exercise on the Health and Social Care Bill on 13 June 2011. A follow up report on its latest phase of engagement will be published in the coming weeks and integrated care is one of four work streams set up as part of this engagement exercise.

Dr Jennifer Dixon, director of the Nuffield Trust, said: “Let’s make integrated care real for patients, particularly older people - it is about time. The Department of Health can create an environment in which integrated care can flourish - this is less about extra spending and more about removing rigidities in the system and encouraging creativity.

“If not now, then when?”

Read the full report.

A life course approach to women’s health should be adopted to tackle issues such as drinking, smoking and obesity which can affect women throughout their lives, say experts from the Royal College of Obstetricians and Gynaecologists (RCOG) in a new paper.

The RCOG’s paper, called Why should we consider a life course approach to women’s health?, is calling for a more unified and woman-centred approach to health promotion, disease prevention and management and says the current organisation of women’s healthcare is disjointed.

Women need consistent, accurate information to equip them at an early stage to make better decisions about their health, for example, how their fertility changes as they age, about healthy eating and exercise to avoid excess weight gain that adversely impacts their health and their children’s health.

The paper highlights smoking and alcohol as major concerns for women. They are both associated with poor pregnancy outcomes including miscarriage, preterm delivery and low birth weight and impaired fetal development. Alcohol affects a woman’s ability to conceive and passive smoking puts children at increased risk of respiratory disease. In addition, drinking above recommended limits and smoking are risk factors for many chronic diseases in later life.

A life course approach also means understanding the link between past reproductive experiences and current or future health, and ensuring that clinicians are alert to the reproductive histories of their patients. For example, roughly half of women who experience gestational diabetes will develop type 2 diabetes within 10 years and women with hypertensive disorders in pregnancy are more likely to develop future cardiovascular disease.

The paper also highlights the need for greater integration of services across different sectors. For example, the traditional separation of contraceptive services and antenatal services hinders delivery of effective preconception care or postnatal contraception which are both key to achieving control of fertility and healthy pregnancies and children.

Professor Judith Stephenson, from the UCL Institute for Women’s Health and lead-author of the paper, said: “Current configuration of women’s healthcare reflects the interests of separate medical specialities and this may not meet the full spectrum of women’s healthcare needs.

“A life course view offers a more joined up approach with implications for long-term health gain and places the emphasis on education and early intervention.”

Professor Scott Nelson, from the University of Glasgow and co-author added: “It is essential that patients and health professionals take a long term view to reproductive health, given our ability to identify early women at risk of pregnancy complications, diabetes and heart disease. Every health care interaction should ensure that women are in the best health for the next stage in their lives.”

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Many practical issues around governance and leadership need to be addressed if health and social care organisations are to improve integration and deliver better care for patients, a study says.

Integration of health services is a hot topic following recent changes to the Health and Social Care Bill, with the health secretary now saying it’s of a higher priority than the introduction of competition.

The study, called Integration in Action: Four International Case Studies, is based on analysis of four separate organisations in Europe and the US that have made good progress integrating health (and in one case) social care services, despite a challenging policy climate.

Across all four sites, several external factors were found by researchers to have driven integration, with for example the prospect of reduced payments to doctors by funders was a key catalyst for integration. External forces could also act as a constraint,  however, with payment systems inadvertently discouraging integration between providers in some cases, and data protection regulations sometimes limiting the degree to which personal information could be shared between health professionals.

The organisations covered by the study were notable for having found routes around such hurdles by focusing on operational processes that helped to align incentives and practices across teams and organisations. Six ‘integrative processes’ were identified by the researchers: clinical, organisational, informational, financial, administrative and normative.

Of these, leadership and effective governance arrangements were particularly critical to developing shared objectives and embedding positive interaction between clinical tools, and the intelligent use of data and IT systems. In some cases targeted payments linked to the performance of specific tasks were also used to encourage the greater coordination of care.

The findings hold lessons for the current debate in England on how to organise and deliver more integrated and seamless patient care.

Specific issues include the tension between choice and integration; the financial incentives associated with Payment by Results that reward hospital activity in preference to integrated, community based services; regulatory and assurance frameworks that divert managerial and clinician attention away from integration; and public resistance to service reconfiguration that may be needed to support integrated care.

The study says national policy is important in providing an encouraging context for integrated care to develop. As the systems for regulation, accountability and measuring outcomes are redeveloped in the NHS there is a window of opportunity to promote a supportive context for integration.

In particular the NHS Commissioning Board and Monitor may wish to consider developing more radical models for bundling payments across pathways, as well as devising regulations that more actively support further integration where it can be shown that this will deliver measurable benefits to service users.

The case studies analysed included Community Care North Carolina, a government funded network that aims to improve access and quality levels for Medicaid beneficiaries; Greater Rochester Independent Practice Association, an independent practice association in upstate New York; Regionale HuisartsenZorg Huevelland, a Dutch organisation providing support to GPs to deliver integrated diabetes care in the Maastricht region; and North Lanarkshire Health and Social Care Partnership, an NHS and social care partnership in Scotland.

Dr Rebecca Rosen, senior fellow at the Nuffield Trust and one of the report’s authors, said: “There is now a window of opportunity to promote moves to deliver more integrated and seamless care for patients following the government’s commitment to amending the Health and Social Care Bill.

“Our international study underlines the fundamental importance of building a shared vision and goals across different providers and teams, developing robust operational processes and drives home the crucial role that that trusted and respected clinical leaders play in this respect.”

Read the full report.