Currently, in the United Kingdom, health
and social care services are fragmented, and therefore unable to respond to the
needs of the population.
Aware of this, the government is
committed to promoting the integration of care in the different areas of action
of the National Health Service (NHS). See more: medical device development.
For this, the "King's Fund",
an entity committed to the integration of care, has developed a guide that
guides the process of turning this intention into a reality, presenting a
summary of "key steps" that will result in changes in the terrain, in
a real, local way, and at the necessary and desired scale.
The authors summarize in 16 steps the
process of converting the integration of care into a reality, and are based not
only on work previously prepared by themselves, but also on opinions and
witnesses of experts and actors involved in the topic, to share the good
practices.
Will the road to the integration of care
progressively be made or do we have to change gear? A first premise pointed out
by the authors is that the incremental adjustments to current services and
practices will not be the way to face the existing pressures, financial and
quality of services. In fact, a real change of pace and a strong commitment to
the future of austerity expected for public services is needed.
Likewise, this commitment will have to
be transversal to the entire system, and it can not be limited to health and
social care services only. We must also involve all the services that influence
the health and well-being of societies.
In this sense, the first actions are
structured around the creation of a consensus, of all those involved, with
respect to the common cause, to the shared vision and to the objectives,
together with the teams of professionals and users.
The work dynamics, the shared leadership
and the management of the temporal and procedural change are key for a clear
understanding and progression. On the other hand, a prioritization and
selection of the areas with the greatest potential for improvement should be
made, which should, in turn, also affect the architecture of the system. In
this aspect, for example, the importance of the creation of multidisciplinary
teams is highlighted, with professionals and clinicians in agreement with the
area or service that is being integrated, which is not identical to the merger
between organizations.
Is there an infallible
"formula" for the integration of care, or is the process based on the
discovery and lessons of experience? It must be clear that there is no single
way to integrate care, and in addition to identifying and making a
"pool" of available services and resources, we must be open to
innovation in the contracting of services, as well as to the model of prices or
incentives to establish.
Greater participation and awareness
among users is also of great importance for the proper functioning of
integrated systems, as well as the circulation of patient information, so as
not to slow down the integration of services.
Finally, we must be prepared and be
realistic with regard to necessary investment, before we can move towards the
integration of services and take into account that, although there is room for
improvement in cost optimization, related to duplication of services or waste,
there is no evidence that integration allows services to be delivered globally
at a lower cost.
The experience of the organizations that
have already made the transition indicates that the road is long and arduous,
and the approach of this type of intervention towards integration (considering
a minimum of 5 years, and in many cases even more) requires that all these
initiatives are articulated in a joint strategy.
Once there are no universal or unique
solutions, the authors stress the importance of discovering rather than
designing, and sharing experiences and good practices when developing
initiatives.
There are already many initiatives in
practice on these same issues, simultaneously, in different locations and areas
of the NHS, so this last recommendation is essential. But it is also essential
that there are key changes in the policy, at the governmental level. This may
include changes or adjustments in payment systems, for example, so that changes
and local actions are possible from the point of view of the incentive.
Likewise, part of the integration of
services in the field also goes through the policies, regulations and financial
and economic framework applied by the government, to support and specify the
process.
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