Integrated Health and Social Care?
Of course we need to share information
but…….
Ken Eason
Emeritus Professor
Loughborough University
The Bayswater Institute
London
k.d.eason@lboro.ac.uk
The Need and the Problem
• The Need
There are growing numbers of:
• Vulnerable elderly people at home
• People with long-term conditions at home
who may need complex health and social care
•
The Problem
– Health and Social Care are separate services and support is
offered through many different agencies
– We need integrated person/client/patient-centred care but we get…
– Fragmented and uncoordinated services
•
The Solution
– We need to be able to share client/patient information across ‘the team’ to
promote integrated person-centred care
Who needs to share information?
Mental
Health
Hospital
Specialists
Friends
Family
Carers
Community
Nurses
Social
Workers
Ambulance
Services
GP
Health
Services
Charities
Patient/C
lient
A&E
Police
Social
Services
So what’s the problem?
The Target
Ideally we need a ‘team’ of people working together and sharing information so that
each client/patient can receive person-centred, integrated care
Structural Problems
Professional/Ethical Issues
What is this ‘team’?
What can be shared with whom?
Many different agencies with different agendas
Many different information systems
The ‘team’ for each client/patient:
• Has permeable boundaries
• Is different for each client/patient
• Is changeable over time, e.g. ‘stepping
up’ in times of crisis
• Is virtual (little opportunity for
everyone to meet)
• Includes the patient/client (selfmanagement opportunities)
• Many different kinds of
contributors, e.g. family members,
health professionals
• A range of different legal
responsibilities, authority over
resources etc
• Patient/client records are
confidential: who can ‘read’ and
‘write’ issues
• Each profession has its own
technical language
Four Routes to Solutions
Approaches
Examples
1. Process solutions
Diabetic pathway and
protocols
2. Macro Organisational Solutions
3. Micro Organisational Solutions
Integrating Health and Social
Care
Integration Facilitators
4. Information System Solutions
Shared Electronic Records
How to share information?
1. A long-term condition pathway e.g. diabetes
Mental
Health
Friends
Family
Patient/C
lient Benefits
e.g. The Diabetic Pathway
Hospital
Specialists
Community
Nurses
GP
Health
Services
A&E
Charities
Social
Carers
Workers
• Shares information,
as needed,
between patient and professionals
• Can promote self-management
Ambulance
• Can include dedicated telehealth
Services
Issues
Social
• Leaves Police
out all other stakeholders
Services
• How to cope with multiple long term
conditions?
• Pathways can be ‘prescriptive’: do
they match the reality of patient
care?
How to share information?
2. Organisational Integration of
Health and Social Services
Friends
Family
Charities
Mental
Health
Hospital
Specialists
Health
Services
Patient/C
lient
Community
Carers
Patient/C
Nurses
lient
Benefits
Social
Ambulance
•
Aligned
organisation:
‘All
singing
from
the
GP
Workers
Services
same hymn
sheet’
• Shared electronic information systems
A&E
Issues
• Still leaves out important
stakeholders
Police
Social
• Will it actually align the goals of all
Services
agencies?
• It could be a very long time coming…
How to share information?
3. Integration Facilitators
Mental
Health
Family
Friends
Charities
Patient/C
Community
lient
Benefits
Carers
Social
Matrons
• Community
A local agency with responsibility for
Workers
Hospital
coordinating
care on a case-by-case basis
Nurses
Specialists
• Can ensure everyone
relevant (including
MultiAmbulanceinformation Case
Primary patient/client) has
up-to-date
Disciplinary
Managers
Services
Care GP
Teams
Navigators
Issues
• Each agency tends to have a partial ‘reach’
Police
A&E
• What access do they have to relevant
Social
Health
information systems?
Services
Services
• Do not have authority to coordinate
services. What strategies can they use?
How to share information?
4. Shared electronic patient/client information systems
Shared, virtual, up-to-date, case-sensitive, accessible, confidential….
Benefits
Issues
Friends
Charities
•Mental
Accessible to allFamily
stakeholders
• Read and write access control: who
Patient/C has access to what information?
• Health
Up-to-date so all know ‘state-oflient • Managing emergent boundaries
play’
Social of
team in each
case
Carers
Workers
Hospital
Community
Technical Opportunities
• Usability: by clients/patients; by
Specialists
Nurses
• Mobile technology
‘mobile’ care staff etc
• Patient and client information
• Who manages/coordinates the
Ambulance
systems? GP
system for each patient/client?
Services
• Telehealth and telecare
Social
Health
• Self-management education and
Services
Services
Police
A&E
support
Some tentative conclusions
• Need solutions that integrate processes, organisation and
information systems
• Need macro frameworks that facilitate…….
• Local, dynamic, case-by-case solutions
– establish the care package and configure the information
system
– opportunities for team members to build trust and shared
understanding
• Do it soon (I haven’t got much time!)