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Integrated care in Northern Ireland, Scotland and Wales Chris Ham Chief Executive, The King’s Fund

Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

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Chris Ham, Chief Executive of The King's Fund, looks at what the health and social care system in England can learn from the experiences of the other countries of the United Kingdom.

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Page 1: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Integrated care in Northern Ireland, Scotland and Wales

Chris HamChief Executive, The King’s Fund

Page 2: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

What was the aim of our study?

Different countries in the UK have taken different routes to health care reformNorthern Ireland, Scotland and Wales have adopted simpler, integrated structures than EnglandGovernments in these three countries have also turned their backs on competition and emphasised the importance of collaborationEach country has sought to promote integrated care in its own wayWhat are the lessons for England?

Page 3: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

How did we carry out the work?

Experts in these three countries were commissioned to write papers using a common formatThe papers describe the structures and policies in place and their impactThey also present examples of innovations in integrated care in each countryThe drafts were discussed and reviewed by the authors and staff at The King’s Fund

Page 4: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Variations on a theme

Northern Ireland has had an integrated health and social care system since 1973 with a commissioner/provider splitScotland has had an integrated health care system since 2003 without a commissioner/provider splitWales has emulated the experience of Scotland since 2009In Scotland and Wales local authorities continue to provide social care

Page 5: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Key messages

Structural integration brings few benefits unless accompanied by many other changesNorthern Ireland has not realised the potential benefits of integrated health and social careScotland has made most progress for reasons outlined laterWales has only moved to an integrated health system recently and it is too soon to make a proper judgement

Page 6: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

What factors matter other than structural integration?

1.Coherent policies that promote and support integrated care – including a national performance framework and a single outcomes framework

2.Governance arrangements that enable different organisations (especially local authorities and NHS bodies) to work together to develop joint integrated care strategies

Page 7: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Lessons learned

3. Political, managerial and clinical leadership at all levels that ensures a clear and consistent focus on integrated care

4. Organisational stability to avoid distractions and delays

5. Willingness to challenge and overcome professional, cultural and behavioural barriers to integrated care within the NHS and between the NHS and social care

Page 8: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Lessons learned

6. Commitment to integrated care as a policy priority for government as a whole

7. Maintaining this commitment over sufficiently long period to enable policies to have a measurable impact

8. Financial support and flexibilities to enable introduction of new models of care (eg, Change Fund in Scotland and ‘invest-to-save’ schemes in Wales)

Page 9: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Lessons learned

9. Information sharing both within the NHS and between health and social care

10. An ability to manage the differences and tensions that arise when public services are organised differently (eg, in Scotland and Wales, there is commissioner/provider separation in local authorities but not in NHS)

Page 10: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

What are the implications for England?

The government will announce a programme of integrated care pioneers in the autumnIt is also developing a plan for vulnerable older people which will emphasise the need for integrated careThe challenge will be to move towards virtual integration in England as structural change is not on the agendaThis could be an advantage if policy-makers are willing to heed the lessons from elsewhere

Page 11: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Implications (2)

Policy-makers in the Department of Health and other national bodies should study the lessons we have identified and act on all of themThere should be a long term commitment to integrated care across governmentPolicy barriers should be removed or amended eg, perverse incentives like payment by resultsHealth and wellbeing boards could play an important roleThe allocation of £3.8bn in the spending review could help to galvanise change

Page 12: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Implications (3)

Much will depend on alignment of political, managerial and clinical leaders to bring about changeThere needs to be a strong and shared commitment that integrated care is the right route to takeThe risk of organisations looking after their own interests rather than working together must be managedPerformance management and outcomes frameworks need to be aligned

Page 13: Chris Ham: Integrated care in Northern Ireland, Scotland and Wales

Finally

Integrated care is the right thing to do but it is also hard to doThis is why successful examples are still few and far betweenA transformation is needed to develop the services required for an ageing population and to meet the challenge of multimorbidityPersistence over time and committed leadership are key ingredients