Healthcare is not a simple, standardised service - many people have complex care needs and all too often, patients and service users experience health and social care services that are fragmented, difficult to access and not based around their and their carers' needs.
Services are often provided by several different health and social care professionals, in a number of settings across different providers, without appropriate coordination or a holistic perspective. For example, cancer patients may need to access specialist care centres far from home, but receive follow-up care at their local hospital. Those who suffer from multiple long-term conditions, including older people, could find themselves simultaneously under the care of a hospital consultant, a community nurse and a local dementia liaison service.
The impact of fragmentation is that quality of care for patients and service users does not reach its potential and that possible efficiencies are not made. Individuals can get lost in the system, access to services can be blocked or get delayed or duplicated, and the quality of care can decline. This is just as much of a problem between different NHS services as it is between NHS and social care services. Therefore, there are significant opportunities to promote the interests of patients and service users through ensuring that health and care services are co-ordinated and meet their needs: more integrated, better co-ordinated care is a means of improving service user, carer and family outcomes.
The Health and Social Care Act (2012) sets out an explicit focus on the importance of integrated care. Monitor has a duty to consider how it can enable integrated care where this improves the quality (outcomes or efficiency) of services or reduces inequalities of access or outcomes.
While it will be for commissioners, working with local providers, to develop and fund better and more integrated patterns of care, Monitor's role as the sector regulator will be to work with others, particularly commissioners, to remove any barriers and consider how to enable integrated care provision where this is in the interests of patients.
Monitor wishes to be clear that we support better integration of health services where this is of benefit to patients. We believe that there are significant opportunities to promote the interests of patients through the integration of care and are fully supportive of any changes to the reforms that make this clear and help us to make this happen. It is our view that competition and integration are not mutually exclusive and that competition does not and should not have to come at the expense of beneficial coordination.
Monitor's integrated care role will be supported by the new provider licence, which will enable Monitor to step in where integrated care is not being delivered, in spite of decisions and efforts made by commissioners. We consulted on the new provider licence and published our feedback from our engagement to date.
The Integrated Care Condition states that all licence holders shall not do anything that could reasonably be regarded as detrimental to enabling integrated care. It also includes a patient interest test which means that the obligations only apply to the extent that they are in the interests of people who use health care services.
In most cases, we would expect integrated care to be delivered locally by commissioners specifying their requirements and working with providers. The requirement for care to be delivered in an integrated way would be captured in contracts, and our policies in areas such as pricing would act as our main tools for enabling integrated care.
In June 2012 we published Enablers and barriers to integrated care and implications for Monitor. This builds on existing evidence about integrated care regarding its definition, evidence for benefits and costs and commentary on who should do what to improve integrated care, including Monitor's role.
The national partners have co-produced Integrated Care and Support: our shared commitment – which sets out our direction of travel to help integrated care become the norm. As part of this, we have developed and adopted a common definition for person-centred, coordinated care and ask local areas to use it too. And to help maintain momentum and accelerate the adoption of new models of coordinated care across the country, we’re also asking local areas to express an interest in being a 'pioneer'.
On behalf of all national partners, the Local Government Association (LGA) published an integrated care and support resource sheet (February 2013) aimed at local health and care system leaders and professionals with an interest, or potential interest, in integrated care and support. It signposts people to information and resources on how best to achieve this successfully within their local health and care economies.
There’s an opportunity for you to be part of an online community (hosted by the LGA) for all parts of the system to share information, knowledge and resources to support more joined up health and care locally. Anyone with an interest in supporting integrated health and care is free to join, download and share information and expertise.
Our aim is to make our work around integrated care consistent and transparent. We will be publishing further reports and guidance on the Monitor website and are happy to receive feedback to our findings and conclusions.
If you have any questions about Monitor's role in enabling and facilitating integrated care, please email email@example.com.