What does integrated care look like to patients?

In today's NHS, no strategy is complete without talk of better 'collaboration', 'partnership' or 'integration' between services. Why? Well, the logic is clear. Siloed working is bad for patients and staff, resulting in poor communication, lower productivity, and frustration.

All providers want is to provide high-quality joined-up care. But what does 'good' look like from the patient's perspective? Earlier this year, our research team looked at the experiences of over 4,000 people to help answer this question.

Integrated care means people come first

People-centred care isn't just about addressing people's clinical symptoms; it means thinking about them as a whole person, reducing duplicated appointments and giving patients confidence that different services are sharing vital information about their needs.

People with multiple health needs often bear the brunt of integration failures. Like the woman who told us that eight different consultants she saw at three NHS trusts were "incapable of communicating with one another, my GP or me", randomly changing medication without reference to other prescriptions and leaving her trying to join up the dots.

Or the woman who described the "exhausting and exasperating" experience of "going around in circles". She had to make multiple phone calls as she was bounced between her GP and hospital to find out what had happened with a referral.

Contrast that, however, with the experience of an Oxfordshire man who told his local Healthwatch of the "absolutely fantastic actions" of various parts of the system that enabled his wife to be discharged to the comfort of her own home two days after an end-of-life diagnosis. Everyone worked in sync – from the consultant in the complex medical ward to the staff that ordered the special bed for her front room, arranged the ambulance transport, ensured the right medication was available and set up regular visits from district nurses and domiciliary care workers.

What stood out from people's experiences?

When we looked at people's experiences to understand what they saw as the benefits of joined-up services, four key themes shone through:

1. Understanding someone's needs as a whole person benefits everyone. Staff can provide more effective care because they can respond to people's unique circumstances and history. People are happier because they are treated as individuals and supported to live as fully as possible.
2. Focusing on helping patients through their care journey, communicating well and removing barriers make it easier for patients to navigate their way through care and get help from the right services. 
3. Integrating services helps build positive links with community partners, enabling patients to access a broader range of help and advice. Effective signposting to help in the community is something patients really value.
4. People love the efficiency that comes with well-integrated services. Being able to get timely access to support in a way that suits you is something everyone values.

How can services work better for patients?

Increasingly, commissioners are focusing on developing integrated community teams to promote wellbeing, prevent emergency admissions, or help people recover after hospital stays and illness.

Our evidence shows there are key ingredients to make these teams – and integrated care more widely – a success. These include:

1. Asking patients and carers what goes well – and not so well – as they move between services to identify integration gaps. Too many of the system's metrics focus on time. They don't ask whether the patient and family felt ready, whether the practical care was in place and whether they had to repeat their stories to different services to meet their needs.
2. Involving patients and carers in designing better joined-up services. Like the adult daughter of a dementia patient who made the simple suggestion that the local urgent community response team leave a calling card on departure in the home – and not just notify the GP. This helps relatives know who's been in to see their loved one, who may not recall any details.
3. Promoting personalised care by fostering a culture among all professionals to look beyond the condition and see the whole person.
4. Investing in administrative teams and named care navigators to help people navigate care pathways, signpost to support while waiting and chasing up other parts of the system on the patient's behalf.
5. Investing in the necessary IT to ensure patient record sharing across services – and ensuring staff get the training to make the best use of technology so patients don't have to repeat their stories.

We know that achieving genuine joined-up care involves hard work. It requires teams to take and share responsibility for providing patients with the best wrap-around care. It also involves breaking down barriers and having the right technology in place.

However, joined-up care is highly valued by patients and their families, giving them a greater sense of control over their health and wellbeing, and it increases their satisfaction with professionals and providers. 

It is therefore vital that providers strengthen their partnerships to deliver the best possible care for their communities and support patients in a truly personalised way.