The gauntlet for integrated care has already been thrown down. Just as 2011 closed with warnings about how the UK’s current model of healthcare delivery is no longer sustainable, 2012 opened in much the same way.
NHS Confederation chief executive Mike Farrar said that the NHS needed to convince people to wave goodbye to the outdated “hospital or bust” model of care, and urged health professionals to help improve the public’s understanding of the benefits of community-based health services and clinical homecare.
Prime Minister David Cameron went further, issuing a directive to bring health and social care services together, and asking the NHS to give full service integration the same priority as it had previously given to waiting list targets.
This same recommendation was subsequently – but independently - reiterated by the King’s Fund and Nuffield Trust, whose January 2012 report ‘Achieving integrated care for patients and populations ‘argued that integrated care should be the decade’s “number one priority.”
Recent announcements from the NHS Future Forum, in its report on the NHS and information, indicate that winning the hearts and minds of NHS professionals will be a critical factor in achieving meaningful change. The challenge, it would seem, is largely a cultural one.
Information at the heart of strategy
The ability to capture and, crucially, to share information across all facets of the patient pathway is a fundamental requirement that underpins any aspiration to forge a sustainable model of integrated care.
At present, the way in which information systems have become embedded into the NHS – with a wide variety of individual systems set up across primary and secondary care, as well as in palliative and social care – has led to a health service that generates islands of information. But does precious little with it.
Historically, systems have often been built in a ‘tribal’ fashion by (and for) common NHS groups such as secondary care consultants, GPs, and primary care trusts. In the main, however, they have each proceeded to keep their information to themselves and have appeared unwilling to share it.
But if we really do intend to put the patient at the centre of care, the whole model for healthcare delivery, and the informatics that support it, is going to have to change. And the cultural mindset of those who operate within the system will need to change with it.
A new age
The NHS Future Forum has said that the health service needs to drag itself out of the “information dark ages.” It has also accepted that patients should be provided with access to any information that is pertinent to their own therapeutic process.
But in an environment where good technologies that can help support information exchange are already well established, the Forum has been quick to place the onus for change on the healthcare professionals that have previously resisted progress.
Yet, of course, responsibility for delivering a workable infrastructure for information exchange across health and social care should not be placed solely at the door of those that work within the system. Progress will require a collaborative effort – and both politicians and informatics experts will need to play a major role in driving the new environment.
The government’s NHS Information Strategy, which will finally be published this April, should help provide a framework and a timetable for change.
Ahead of that, the Forum’s recommendations reinforce the call for the universal adoption of the NHS Number across health and social care by the end of 2013 – a challenge that should, at the very least, sharpen the pencil for mindset change and enable interoperability between systems.
Talking to each other: system interoperability
Much of the technology to facilitate an information revolution within an integrated care system already exists – it simply needs joining together.
At present, it is practically impossible to track patients as they move from one part of the NHS organisation to another and, as a consequence, the islands of information merely perpetuate. But with greater connectivity – interoperability – this dated model could quite quickly, and simply, become transformed.
There is a growing will among more forward-thinking NHS professionals to work in partnership with technology suppliers to address the issue of interoperability.
Proactive clinical providers are increasingly attempting to improve communications with their peers in primary, community and social care, and are helping to pioneer efforts to link systems in ways that can transform service delivery right across the patient pathway.
In the process, they are helping to convert islands of information into islands of excellence that can act as exemplars for others to follow and, indeed, improve upon.
Disruptive innovation
There has been much talk in recent months of the concept of so-called ‘disruptive technologies’ – the notion that something very simple can transform the way we do things and, at the same time, make that process much more efficient.
The consumer world is full of examples of disruptive technologies that were dismissed when they were first introduced but have gone on to become an essential way of life. ATMs – the ‘hole in the wall’ machines that have replaced many functions of bank tellers - are a perfect example.
Healthcare, now more than ever, needs to embrace the concept of disruptive technology and explore ways in which it can move steadily towards meeting some of the ambitious objectives being thrown at it by the reform agenda.
Facilitating interoperability may yet prove to be that simple solution that acts as a game-changer – but this will not happen by accident: healthcare professionals have got to want to make it happen.
Other industries, notably airlines and banking, faced – and overcame – the challenge of interoperability years ago. They did so because they wanted it to work. Healthcare must develop the same appetite.
Taking small steps
The journey towards integrated care, supported by an ‘information revolution’ that hopes to arm patients and clinicians alike with the right information at the right time – with the patient at the centre – does not need to be viewed as a giant and hurried leap into the unknown.
For healthcare professionals, the move from rhetoric to reality can be achieved by adopting some simple solutions. There are examples of disruptive technologies – small, simple applications – that allow people to review the way they work and do things differently yet more effectively.
We are not going to go from the old world systems to a new way of working in one jump – but small, incremental steps, starting perhaps with a willingness to link systems together, can help the NHS make a steady journey towards integrated care. And from fragmented islands of information, build bigger and more effective islands of excellence.
About McKesson: McKesson UK, a subsidiary of McKesson Corporation, is a healthcare technology solutions and services provider specialising in workforce, clinical and administrative information technology and medical imaging solutions. It has operated in the UK since 1990.
