Integrated care Resources

Several crucial documents have identified the need for integrated care to meet patient requirements in the current financial climate, developed from the concepts of self-care and joining up care to improve health outcomes. These include the Five Year Forward View (2014), Next Steps on the Five Year Forward View (2017), NHS Long Term Plan (2019) and now the introduction of the Health and Care Act (2022) — all of which provide a contextualised approach to care. Integrated care is aimed at the way that organisations work together to support self-care (which incorporates the principles of holistic care considering physical, emotional, social, spirtual and ecomonc health [Mills, 2017]), with a commitment to improve patient outcomes by avoiding confusion and repetition. It  enhances comprehensive care planning by listening to patients — perhaps best summed up by the phrase, ‘No decision about me, without me’ (Department of Health [DH], 2012).

The aim of this retrospective, real-world cohort analysis was to explore the clinical and financial benefits following the implementation of integrated care bundles (ICBs) within a real-world cohort of multiple wound types across two large community care facilities in Ontario, Canada. An observational, retrospective cohort analysis of the effectiveness and safety of a series of wound-specific ICBs, adopted to improve the management of open chronic wounds, was undertaken. Outcomes from patients who received a multilayered,
silicone adhesive foam dressing as part of their ICB were compared with outcomes from patients who did not receive the ICB. Patients who received the ICBs, including treatment with the foam dressing (n=16,841), experienced improved outcomes compared with those who did not receive the ICB (n=2242), including a faster time to healing (12.8 vs 25.5 weeks, respectively), and longer time between dressing changes (3.5 vs 1.9 days, respectively). Decreased mean nursing visits in the ICB cohort led directly to reduced resource costs, compared with mean per patient costs in the non-ICB cohort (CAD$1733 vs $6488, respectively). It was found that the reality of delivering evidence-based best practice that is optimally placed to deliver good outcomes can be challenging. However, the authors’ experience suggests that the adoption of pathways and ICBs may
make it easier to adopt best practice.

A move towards integrated health and social care provision has been a key policy driver in the UK since 2010, underpinned by a belief that this is essential to provide holistic, person-centred care while transforming service provision. Progress towards achieving integrated care has been slow, and now Brexit poses a further challenge, as attention is focused on preparations for a ‘no-deal’ scenario. Ensuring that the NHS and social care systems are able to continue to function after March 2019 is now a key concern for those leading and managing frontline services, and measures are being put in place to deal with potential disruptions caused by a no-deal Brexit. This includes dealing with issues related to the recruitment and retention of European economic area (EEA) staff into the NHS, disruptions in the supply of medicines across European Union (EU) borders, challenges to the recognition of professional qualifications and patient safety, and health protection and health security within the UK post-Brexit. The imperative to prepare for a worse-case scenario diverts attention away from other key policy drivers, such as integrated care provision. It may also serve to reinforce a view of integration as a cost-cutting exercise, rather than as an approach to promote better care for patients. A move towards the transformation of care through integrated provision offers real potential for improved patient outcomes in the future, and a revitalised health service. However, Brexit has the potential to disrupt the integration agenda as financial resources and staff time become focused on dealing with the fall-out from Brexit, rather than on frontline patient care. Community and practice-based nurses and staff are in the frontline of integrated service provision, and in the next few months may be some of the first staff to witness the negative impact of Brexit preparations on the provision of integrated care.

Sue Dawson and Mohammed Sharif describe the work of the community cardiac rehabilitation worker
Sue Dawson RGN, Dip Prof Studies, BA (Hons), Post-Graduate Cert in Independent Practice (Nursing) is Clinical Effectiveness Lead/Nurse Practitioner, Bradford City PCT. Mohammed Sharif DPSI is a Community Cardiac Rehabiliation Worker Bradford City PCT, CHD/Diabetes Team. Accepted for publication June 2003