Over 800 delegates from all over the world came together for the conference of the international Foundation for Integrated Care. This year’s topic was ‘enabling integrated health and social care’ and coincided with policy developments in Catalonia, where the Catalan government has been implementing an inter-departmental plan for health and social care integration for the past three years. ESN was involved in preparations as a knowledge partner and its Policy Director Alfonso Lara Montero was a plenary speaker and also presented at a workshop ESN’s recent report on integrated services with Mirella Minkman from Vilans.
Alfonso shares with us some insights from the conference.
The conference was an excellent opportunity to listen to and share experiences about the latest evidence on integrated health and social care. For instance, Nicolas Mays, from the London School of Hygiene and Tropical Medicine, gave us an insight into the early evaluation of England’s integrated care pioneers, which seek to advance the agenda on integrated care. Mr Mays spoke of ‘pilotitis’ –the fact that a significant number of integrated care projects have already been implemented but not translated to the mainstream. He also explained the difficulties in isolating the specific impact of integrated care in delivering better outcomes for service users. Maria Chiara Corti, from the regional government in the Veneto Region (Italy), spoke about the structural reorganisation and better coordination between hospital and services in the community that they have been implementing in the Veneto Region for the past decade.
In ESN’s recent report on integrated social services we documented practices from across Europe highlighting ways of improving cooperation between professionals from different sectors working with the same client, improved governance, or the integration of various strands of finance by pooling budgets. For example, UK councils have started to implement home teams with a multidisciplinary group of therapists, nurses, social workers and home care workers. MAIA (Maison pour l’autonomie et integration des maladies Alzheimer) in France is a service implemented by local authorities consisting of integrated care teams of professionals (doctors, nurses, social workers, therapists) working with older people and individual case management.Based in the same place, multi-disciplinary teams provide a response to older people and those living with long-term conditions in the community.
These are not unique models and similar examples have evolved across Europe, and not just in health and social care for adults but also for children. For instance, the Early Years Collaborative with the support of the Scottish National Health Service, the Coalition of Scottish Local Authorities and the Police is a multi-agency programme implemented locally and delivered nationally to provide children with the best start in life.
The journey towards integration has not been an easy one for a number of reasons. There is a cultural issue about the way in which social workers and clinicians work. Whilst social care values are derived from social work and emphasise people’s empowerment, those of medicine are more focused on specific health needs. Differences in pay scales between the national health care system and local authorities’ social services could force costs upwards or downwards. The indicators against which the success of the integration process should be measured should include not only typical medical criteria, such as the reduction in emergency admissions, but also social client satisfaction and wellbeing.
I took home three important lessons. People matter as does the place they live and outcomes for individuals and their communities. The manner and end result of practice is what matters most and therefore the aim should be to provide excellent care, as was highlighted during the discussions. However, often focus is placed too much on structure, procedure, strategy and planning. This means we may then forget that integration should be aiming at good practice – not be a substitute for it.