ESN at 14th International Conference on Integrated Care
How to integrate services in order to provide person-centred care? This was one of the key questions at the 14th International Conference on Integrated Care on 2-4 April in Brussels, attended by researchers, local authorities and health care providers.
“Technically and clinically I received very good care, but it was not person-centred. The only time somebody talked to me was to ask for my name”, said Robert Johnstone from the International Alliance of Patients’ Organisations about one of his hospital experiences. Mr Johnstone has been living with chronic rheumatoid arthritis for 58 years and is a self-managing patient who has found other ways outside the clinical health system and traditional medication to manage his long-term conditions.
Different models of integrated services
The discussions at the conference focused on horizontal integration (between primary, secondary and tertiary health care) and vertical integration of services. It became evident that there are policies to implement efficient and person-centred service provision in many countries. However, there are also many different actors in the health and social care system who might have conflicting interests. The health sector makes up a large share of national GDP, but is already quite fragmented between specialist, community health and hospital care. Health care services are provided by trained staff, often in a hierarchy between nurses and doctors. Social services are often underfinanced, a large part of social care responsibilities relying on informal carers. Social workers are often perceived by health professionals at the bottom of services delivery chain – this makes cooperation between health and social services difficult.
Researchers and policy makers presented different models in Europe, America, Australia and New Zealand that aim to overcome the fragmentation within the health and social care systems. Scottish government policy implements partnerships between health and social care with integrated budgets. Local authorities like Torbay in England integrate care by using the virtual ward guide. Solveig Samson from South Devon and Torbay Clinical Commissioning Group explained the case-management approach in the virtual ward: “The case manager gives a person a single point of access, they discuss together psychological wellbeing, social needs and support, personal and spiritual needs.” As a result of this approach, Torbay has had a decrease in the number of hospital admissions by 24% and individual stories show successes in terms of the continuity and quality of care.
Rafael Bengoa, Director of DEUSTO Business School in the Basque Country, Spain, explained the transformation of services in the region. He emphasised that targeted population management is needed to plan services and both a top-down approach, including commissioning, stratification and record sharing, and a bottom up approach that enhances health and social care coordination and patient empowerment, are needed to integrate services. Other speakers from the US, Canada, Israel and New Zealand described their national steps towards better coordinated and effective services. In Canterbury, New Zealand, General Practitioners (GPs) were crucial in developing individual health pathways and a shared electronic system between health and social care was set up after an earthquake. Kenneth Kizer who represented the fully integrated Veteran’s Health Care system in the US underlined the need to address social needs as well as clinical needs in order to establish person-centered care.
The role of service users and communities
The role of services users and communities was an important topic at the conference. Henk Nies from the Dutch Centre of Expertise in Long-term Care noted that, although health care is still illness care, there is a paradigm shift towards a re-definition of health and care and the role of the service user as a person with different social roles. He opened the discussion on ownership of care by asking: “Do I own my health care? Or is it owned by organisations and public authorities? Do municipalities contract services for me or can I do that myself with personal budgets?” He also mentioned Dutch initiatives within communities where citizens organise care themselves, such as non-monetary currencies, with people trading their time.
Examples of coordinated services
- The region of Southern Denmark implemented an ICT system that builds on all information systems in hospitals, medical practice and social care, which can also be used by service users to keep track of their own care.
- Catalonia in Spain has a multi-level regional plan for the integration of health and social care, which consists of shared clinical records, a new model for contracting services, shared individual intervention plans for chronic patients, integrated pathways with social services and an integrated home care model that aims to promote active ageing and disease prevention. This strategy has been implemented at local level in the municipality of Tona. A multi-professional team designs individual care plans with different services: basic social services, specialised dependency services, telehealth and the primary health care centre.
- The Dutch programme Embrace provides integrated care for older people and involves insurance companies, GPs, hospitals, welfare services and community groups. A team led by a GP consisting of a district nurse, a social worker and an elderly care physician develops individual care plans and enhances self-management. They allocate older people into three groups: older people who are involved in group activities to prevent decline and social exclusion; frail older people that are visited by social workers who also act as case managers to put the right services in place; people with complex care needs that are visited by a district nurse. The team discusses each case individually. University professionals presented first results from a randomised control trial that started in 2012. They show that older people in the programme feel safer and more secure. A business case based on actual costs for municipalities, the health care insurer and the long-term care insurance extend Euro 274 savings per person per year.
- The Swedish local governments commissioned a study on 19 local projects on integrated care for people in nursing homes. The initial problems were unnecessary hospital admissions, a burden on families and unnecessary use of resources. The 19 projects included new forms of organisation, case management, collaboration such as flexible use of beds in care homes or a mobile medical team to make acute home visits for people with severe heart problems.
The European Social Network (ESN) will investigate effective ways of coordinating care with our members and within the Action Group on Integrated Care in the European Innovation Partnership on Healthy and Active Ageing.