What does ‘integrated care’ really mean?

In the run-up to the general election, we heard a lot from political parties about how the NHS and social care need to change, and particularly how health and social care need to ‘integrate’. But what does this really mean? And will it make any difference to us all as patients, carers and users of services?

The aim of integrated care is that health and care services will centre around the individual. For example, mental and physical health would be looked at together, not separately, and NHS and social care services would ‘talk’ to one another in order to provide ‘seamless’ care.

It’s hoped that there will be far fewer chances of people and carers ‘falling between the gaps’ as they move from one service to another.

Many service users and carers we speak to tell us about how they wish services were more ‘joined up’, and that when an individual is transferred from one service to another, for example from a hospital to support at home, information can be lost and standards in care can differ.

One of the most powerful stories we’ve heard articulates the need for the integration of health and social care services perfectly. This is John’s story.

After 30 years of marriage John became a full time carer for his wife, Ann, in the last year of her life. She went on to die of breast cancer that had spread to the brain. John spoke to us about how in that year he became an ‘accidental carer’, thrust into a role he had no experience of.

“Ann was first diagnosed with breast cancer before Christmas 2006”, John begins. “After four years of gruelling treatment and an “all clear” diagnosis at one point we were told that … surgery was not an option for her and … she was handed over to Palliative Medicine.”

“The handover … was particularly traumatic and badly handled. There was no discussion of possible further treatment and no sensitivity displayed. We felt abandoned.”

After this poor experience of handover between departments within the NHS, John told us that the current divide between the NHS and social care services proved even more traumatic.

“The two are not joined up and do not work together. The resulting bureaucratic mire is extremely difficult to navigate – especially for carers who are already under a lot of strain and do not have the time or energy to battle the red tape.”

“For example…although in my heart I wanted to be with Ann all the time, I needed some respite. I approached NHS Community Services about this, and was given two nights per week sit-in care from an agency. But the NHS would not fund any daytime respite as it was not classed as a clinical need for me, or Ann. They suggested I contact Adult Social Care Services – but I was passed on a merry-go-round from one person to another.”

“They were putting pressure on me rather than relieving it and getting neither Ann nor I anywhere. I gave up.”

At Healthwatch Essex, we talk to many people who have good experiences of moving from one service to another, but in the cases where it doesn’t go well, it can do long-lasting damage. We hope that if integration becomes a reality, we will hear of far fewer stories like John and Ann’s.