Ham and colleagues (1) have provided a much needed article on various
forms of clinical integration in community care for vulnerable older
people and patients with chronic disease. This contrasts with usual
evidence free diatribes about the need for more competition in the 'health
economy',dividing purchasers (often primary care) and providers(secondary
care).
I would like to add 3 other points to this discussion based on our
experience of informal integration between primary, secondary and social
services clinicians in Whitby - a small town in North Yorkshire surrounded
by the North York Moors.
1. We have had to integrate our expertise because of long standing
insufficient funding. Therefore, being resource poor can sometimes be
useful because it genarates innovation in order to survive. Recent
interest shown by a number of mental health services from London
concerning our practice of working together, reflects their current
resource and overhead pressures.
2.The main practical objective of integrated care is to set up care
pathways for major disease groups such as cancer and dementia. Integration
of whatever type results in pre ordained pathways, with a variable
evidence base, often applied to populations dissimilar to those studied.
The rigidity of these pathways make them difficult to 'escape' from - for
both patients and clinicians. The alternative approach would be through
patient held budgets (invoving a health and social care charge card) where
care pathways would be organically forged by frequent use. This process
also permits 'escape' when changes of diagnosis and client characteristics
necessitate this.
3. In Whitby we have used informal integration for patients,carers
and professionals to learn from each other; a 'learning network'(2).
Working together and subsequently reflecting on real life episodes of care
have helped to increase our collective competency, and promoted smarter
ways of intervention (often earlier than conventionally stipulated).
I hope that our political masters think again about market reform and
carefully use available national and international evidence when deciding
on the future of community care for vulnerable people reflecting the views
and experience of carers and clinicians.
1. Ham, C., Dixon, J. and Chantler,C. Clinical;ly integrated systems:
the future of NHS reform in England? BMJ 2011; 342:740-742
2. de Silva, P.N. New ways of working with primary care; proactive CMHT or
Polyclinic? Progress in Neurology and Psychiatry, Vol 13, issue 1, june
2009
Rapid Response:
More thoughts on Integration
Ham and colleagues (1) have provided a much needed article on various
forms of clinical integration in community care for vulnerable older
people and patients with chronic disease. This contrasts with usual
evidence free diatribes about the need for more competition in the 'health
economy',dividing purchasers (often primary care) and providers(secondary
care).
I would like to add 3 other points to this discussion based on our
experience of informal integration between primary, secondary and social
services clinicians in Whitby - a small town in North Yorkshire surrounded
by the North York Moors.
1. We have had to integrate our expertise because of long standing
insufficient funding. Therefore, being resource poor can sometimes be
useful because it genarates innovation in order to survive. Recent
interest shown by a number of mental health services from London
concerning our practice of working together, reflects their current
resource and overhead pressures.
2.The main practical objective of integrated care is to set up care
pathways for major disease groups such as cancer and dementia. Integration
of whatever type results in pre ordained pathways, with a variable
evidence base, often applied to populations dissimilar to those studied.
The rigidity of these pathways make them difficult to 'escape' from - for
both patients and clinicians. The alternative approach would be through
patient held budgets (invoving a health and social care charge card) where
care pathways would be organically forged by frequent use. This process
also permits 'escape' when changes of diagnosis and client characteristics
necessitate this.
3. In Whitby we have used informal integration for patients,carers
and professionals to learn from each other; a 'learning network'(2).
Working together and subsequently reflecting on real life episodes of care
have helped to increase our collective competency, and promoted smarter
ways of intervention (often earlier than conventionally stipulated).
I hope that our political masters think again about market reform and
carefully use available national and international evidence when deciding
on the future of community care for vulnerable people reflecting the views
and experience of carers and clinicians.
1. Ham, C., Dixon, J. and Chantler,C. Clinical;ly integrated systems:
the future of NHS reform in England? BMJ 2011; 342:740-742
2. de Silva, P.N. New ways of working with primary care; proactive CMHT or
Polyclinic? Progress in Neurology and Psychiatry, Vol 13, issue 1, june
2009
Competing interests: No competing interests