There have been moves in recent years to combine physical healthcare, mental healthcare and social services provision into a single, joined-up service that can better meet the needs of patients. While most of these attempts have been fairly tentative in nature – relatively small-scale trials rather than a bold, fundamental reorganisation of patient care – the idea itself certainly isn’t new. Even though it didn’t materialise at the time, Barbara Castle, Secretary of State for Social Services in the mid-1970s, was in favour of an integrated health and social care service.
There is undeniably an overlap between physical and mental wellness, and a truly integrated healthcare system has the potential to offer greater efficiencies by providing patients with exactly the right type of care and support at the appropriate times. The successes that can be offered by this type of organisational structure can be seen in the Torbay and South Devon NHS foundation trust, which last year became the first fully integrated care organisation in England.
Groundbreaking Service Integration
The groundbreaking Torbay trust is actually built upon a previously combined service; health and adult social care were first integrated into a single organisational structure a decade ago, before merging with the local acute NHS trust in October 2015. The new integrated service allows for a single overall budget and a simplified management structure. The trust’s IT system is also shared between the different disciplines, allowing for further efficiencies and flexibility.
A similar initiative in Hertfordshire – known as ‘Home First’ – incorporates nurses, therapists, homecare workers and social workers into a rapid response team primarily aimed at the elderly and those with long-term health problems. The multidisciplinary set-up allows for the most suitable professional to be despatched in response to each call, providing the help or treatment that the individual needs. The scheme has contributed to a 3.7% reduction in emergency hospital admissions.
The Challenges Faced
While these and other integrated healthcare teams have delivered some impressive successes, the development of such cross-disciplinary trusts isn’t without its challenges. Any integration of professionals from essentially diverse fields will present steep learning curves to all involved, right down to relatively “trivial” aspects such as differing terminology.
Of course, there’s also the question of whether today’s NHS – which is already struggling to cope with budgetary limitations and other stress factors – is in a strong enough condition to survive the fundamental reorganisation that such integration of services would require.
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