I am not a believer in the wholesale integration of health and social care in the organisational sense.
In my view, the evidence for its potential benefits is less than compelling. Do we really need such a major structural change in health and social care given how bad our record is on achieving it well in recent times? It has the same whiff of bad karma about it as setting out in a small family car during a blizzard. It’s a car crash waiting to happen.
But I do believe strongly in integrated patient care. And, for me, there is an important difference. In the first, organisational needs will come first whatever the mission statements say. In the latter, the purpose is driven by patient needs and priorities.
I am very proud of the fact that, over the last eighteen months, I have played a small part in an important piece of work to set a vision for the development of perioperative care for patients needing surgery.
You can find a copy of the strategy document that was launched by the Royal College of Anaesthetists (RCOA) who are leading this initiative) here: http://www.rcoa.ac.uk/periopmed/vision-document
The aim is to move away from current models of care in which the patient experience is all too often not what it should be. Patients will talk about their experience and how the care given has been fragmented and unco-ordinated across different disciplines and organisations; how it has accentuated their levels of worry and anxiety before surgery. Also how it has impeded their recovery from surgery particularly if they have complex needs.
RCOA’s vision is for the wide-scale adoption of perioperative medicine across health and social care. Some components of the approach have already been successfully adopted in the NHS. They include the Enhanced Recovery Programme launched by the Department of Health some years ago: http://www.rcoa.ac.uk/periopmed/case-studies
But RCOA has set its sights higher on achieving a real change in how people with complex needs are treated when they require surgery.
And the premise behind it is logical and simple from a patient perspective. It is that your care needs are carefully co-ordinated from the point at which the decision to have surgery is taken to the weeks and months afterward. You might call it anticipatory care for this work begins at the point of your assessment when not just your surgery but your likely needs afterwards are considered and planned for. Crucially the perioperative medicine team has a single point of contact to make sure this happens. And it is flexible to adapt to changing needs.
It is an ambitious aim. But the case for it is compelling. With around 250,000 high-risk patients entering surgery every year – about 15% of the total number of people having surgery – the cost of not getting it right is too high for patients and for health and social care system.
RCOA has shown the way forward.