With the House of Lords debating the Health and Social Care Bill last week, the imperative of integration has reached an unusually high profile in health policy debate in England.
Like many other policy priorities, integration can be defined in all sorts of ways. It can mean joining up different services – most often health and social care for example – at one point in time and it can mean offering consistent care over time for people who need long-term support. It can mean improving links between primary and secondary care services within the NHS and it can also mean looking far beyond the NHS’s usual horizons to integrate with a range of other services such as schools, housing, employment and justice, to name but a few.
But integration for some can mean exclusion or fragmentation for others. Writing in HSJ last month, Chris Ham warned of “the wrong kind of integration”, for example when organisations come together but the professionals who work in them remain fragmented in their everyday practices, or when services integrate around specific conditions forgetting that many people with long-term health needs have multiple diagnoses – often including both physical and mental illnesses.
It is therefore crucial that integration does not simply become the latest buzzword in health policy fashion: a box-ticking exercise rather than a driving force for reform. Integration will all-too-easily be discredited if it is not sufficiently well understood or robustly implemented.
There are, nonetheless, opportunities with the reform process now under way to make integration in its fullest sense possible both within health and social care and across a range of other services. The Future Forum’s second work programme has focused on integration and may help to inform the design of the new system to give the best possible push in the right direction. This could have major implications for the way clinical commissioning groups and the Commissioning Board work and are held to account as well as giving health and wellbeing boards and their local authority hosts a bigger influence still in the way health services are planned and developed.
The Department of Health, meanwhile, is currently consulting on the potential of clinical senates and clinical networks to achieve integration within the health system. The potential for clinical networks in mental health is great. With the publication earlier this year of a cross-government mental health strategy, joined-up local and regional action to pursue its objectives is vital.
Clinical networks – if adapted to the needs of mental health services to offer equal voices to users and carers as well as a range of non-health services – could help to integrate support for people with mental health problems broadly and across a wide area. Mental health networks would particularly enable the joining up of services for people requiring more intensive support, for example those in secure services and those stepping down from them to supported housing. They would also support the development of new or expanded services such as police or court diversion, liaison psychiatry in acute care and psychological therapy services.
Above all of these influences, however, integration is dependent first and foremost on good quality relationships within and between agencies. With major structural changes taking place across the NHS and other public services, sustaining these relationships can be extremely difficult. But without them integration will continue to be a policy imperative without its most effective lever for change in place