The problem grew and grew, until we find ourselves in the situation we do today: in which the affordability of our healthcare system is in jeopardy.
Then something changed. We found out that long term conditions can’t be treated in the same way as the communicable and deadly diseases upon which the basis of modern medicine was founded.
The light-bulb moment came when we realised that people were no longer trying to avoid an unpleasant death; patients were now focussed on trying to avoid an unpleasant life. With the rediscovery of William Osler’s maxim to treat patients rather than diseases, came an understanding of the connection between long term conditions and quality of life.
What we need to do for our patients has to revolve around helping them achieve the outcomes that are important to them. Previously we’d been focussed on helping patients achieve the best test results; now we needed to focus on helping them achieve the best quality of life.
Attention naturally switched to how to turn these lofty ideas into practical everyday care. New ways of thinking like Ed Wagner’s Chronic Care Model showed us this requires a partnership between professionals and patients in which the community is as important as the healthcare system.
Integrated, preventative care which spans these various settings became the holy grail. But, at least in the UK, it eluded us. We jealously looked across the Atlantic at organisations like Kaiser Permanente and the Veteran’s Administration, who were achieving great outcomes and patient satisfaction by delivering ‘whole system care’. We contented ourselves that these organisations only reached a small proportion of the US population; in any case, we thought, ‘our NHS’ was different.
But then we stopped theorising and instead just started doing integrated care. Great local initiatives started to spread; Torbay, Greenwich and North Lincolnshire were suddenly on the map. In Gwent, hospital admissions dropped significantly as it integrated health and social care.
The Year of Care Programme showed that improved outcomes could be delivered at a system-wide level and this care provides value for money and a great patient experience.
The Integration Pioneers will be announced in November and will be given logistical and financial support to do integrated care.
Suddenly, we’re not short of our own solutions, but ‘person-centred coordinated care’ (which is what patients wish to experience) is still a rather frail flower.
NHS England and UCL Partners are jointly holding a conference – The Future of Health Conference to be staged in London on October 3 and 4 – which is designed to keep up the momentum in ‘doing’ integrated care. We’re past the point of theorising now; we know the massive challenge of long-term conditions.
We’ve also got some great solutions to this challenge. We need to bring people together to share great practice, and also learn what doesn’t work. We’re trying to do something different with ‘The Future of Health’: how to turn today’s exceptional practice into tomorrow’s normal practice.
Everybody in health and social care has a role in doing this. We’re excited to be involved at this turning point, and we hope you’ll join us.
Ed Mitchell is a junior doctor training in psychiatry, and currently one of Sir Bruce Keogh’s clinical fellows, working in Domain 2 (Enhancing the quality of life for people with long-term conditions) of NHS England with Martin McShane. He has a particular interest in integrating physical and mental health.