What do we mean by integration?
Integration between services within health and social care has been a priority in the national strategic agenda for over two decades. This was enshrined by parliament in the Care Act 2014. With a growing population, improvements in recognition and diagnosis of certain conditions – particularly in mental health and learning disability – were at the forefront. It had become clear that the traditional disconnect between NHS healthcare services and local authority social care services was creating a self-perpetuating spiral.
A lack of quality social care capacity and community support delayed hospital discharge. Delayed hospital discharge led to deterioration, unfitness-to-discharge and “bed-blocking”. Similarly, disjointed community services meant that potentially preventable incidents weren’t prevented.Intervention only occurred after-the-event, resulting in hospitalisation or more intensive recovery action being required.
The move to improve integration of services also brought with it a focus on a more community-based approach. Health and care services were focused where people live, rather than the traditional hospital-based structure. But even with the introduction of local Clinical Commissioning Groups moving responsibility for local services to GPs, social care remained within the remit of local authorities. Incompatible or uncoordinated processes remained also.
Ultimately, this structure directly impacted on the quality-of-life of individuals, referred to and assessed by multiple services that they were allocated or “pigeon-holed” into.
New models of care integration
However, more recently there have been moves towards a more collaborative approach with new models of care. Examples include the integration of health and social care in Greater Manchester, pilots of Accountable Care Organisations, social prescribing and a rise of community interest companies and social enterprises. The aim is to make services more fluid and flexible on a community level in order to maintain as much independence as possible. This effectively turns the “pigeon-holing” into a more flexible, sliding scale.
One of the most common barriers to creating a true “wraparound” person-centred and outcome-focused approach is the fact that the various agencies and services involved will have their own systems.Individuals are being shoe-horned into provider-centric systems, which leads to duplication of data.
True Person-Centred Integration
To illustrate, imagine using a paper-based system. The individual is effectively filling out the same forms multiple times for different services to suit the provider.
A truly person-centred care plan would belong to the individual and they could take it with them between the various services. This is the next step for care plan software to support integration.
There have been local pilots similar to this idea – i.e. standardizing of care management software across multiple providers. Although they have seen improvements in commissioners’ ability to monitor and coordinate between multiple providers, the care planning software tended to be commissioner- and provider-centric for one type of service – e.g. care homes.
To achieve true integration, a local health and social care system needs to utilise a single care plan software product across services, so that every individual has their own support plan that is ‘portable’ between services. This would allow an individual to move between services seamlessly, creating coordinated service delivery that consistently meets their needs and desired plan outcomes.
By extending controlled access of this person-centred support plan to informal circles-of-support such as family and friends, the individual will experience a true ‘wraparound’ package of support. This method promotes independence and facilitates early recognition of potential problems and a coordinated intervention and preventative action plan.
Most importantly, though, this approach puts the individual at the heart of their care and support planning and delivery. It empowers them to take control of which services are accessed, how and when they are delivered and ensure that their needs and outcomes are the primary focus.
For commissioners of services, such a model would allow for a level of standardisation amongst contracted providers and promote greater cooperation and cohesion within the market.
Digital Care Planning, Care of the Future
As the benefits of more cooperative local markets outshine traditionally competitive approaches, this model would give service providers uniformity of formats for plans, reports and other administrative processes.The focus shifts to quality of service delivery and keeps consistency for individuals moving between services.
iplanit is built on a unique architecture that puts the individual being supported at the heart of the system. Support plans, activity records, case notes, risk assessments and outcomes are available in one person-centred digital care management system. The individual has their own log in and the ability to invite members of their circle-of-support into their plan. This functionality was originally designed for family and friends, but we have found that our customers are using it to involve Social Workers, District Nurses, Case Managers and staff from day centres or colleges in their support.
Of the many care plan software options available, we feel that iplanit is best suited to supporting integration on a local level, due to it’s person-centred and outcome-focused design.