Integration of health and social care is a core policy aim of the new coalition government in England. It has several benefits for patients, particularly older people and those with long-term conditions. But how does integration work in practice? This paper sets out how one particular area – Torbay – created an integrated care system that aimed to improve care for ‘Mrs Smith’, a fictitious user of health and social care services.
This case study sets out the background to the development of integrated care, the setting up of a pilot team, the implementation of an integrated management structure, the establishment of Torbay Care Trust (which is a fully integrated NHS organisation responsible for commissioning and providing community health and social care services) and assesses the impact of the integrated system on the performance of the Torbay health and social care economy.
Peter Thistlethwaite, the author of the paper, acted as ‘critical friend’ in Torbay during the years of the formation and establishment of the Torbay Care Trust, and led the action research programme which identified and embedded the early lessons about what worked. He emphasises that there is no ‘textbook’ approach to guide the process as the local context – particularly the interplay of people, relationships and processes – is a key variable. However, he is able to share some important lessons:
- it is important to have a clear vision – and one that is based on making a positive difference for service users – and to monitor progress
- work from the bottom up, bringing together frontline teams and align these teams with general practices and their registered populations
- establish joint governance early and be aware that it is possible to overcome cultural political and organisational differences
- ensure managers and clinical leaders are engaged from the start.