Integrated Health and Social Care? Of course we need to share information but……. Ken Eason Emeritus Professor Loughborough University The Bayswater Institute London

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? Patient/C lient Family Carers Hospital Specialists Hospital Specialists Charities Community Nurses GP Ambulance Services Ambulance Services A&E Friends Mental Health Mental Health Police Health Services Health Services Social Workers Social Workers Social Services Social Services

So what’s the problem?

Four Routes to Solutions

How to share information? 1. A long-term condition pathway e.g. diabetes Patient/C lient Family Carers Hospital Specialists Hospital Specialists Charities Community Nurses GP Ambulance Services Ambulance Services A&E Friends Mental Health Mental Health Police Health Services Health Services Social Workers Social Workers Social Services Social Services e.g. The Diabetic Pathway Benefits Shares information, as needed, between patient andprofessionals Can promote self-management Can include dedicated telehealth Issues Leaves out all other stakeholders How to cope with multiple long term conditions? Pathways can be ‘prescriptive’: do they match the reality of patient care?

Patient/C lient Carers Hospital Specialists Hospital Specialists Charities Community Nurses GP A&E Mental Health Mental Health Police Social Workers Social Workers How to share information? 2. Organisational Integration of Health and Social Services Social Services Social Services Health Services Health Services Patient/C lient Family Friends Ambulance Services Ambulance Services Benefits Aligned organisation: ‘All singing from the same hymn sheet’ Shared electronic information systems Issues Still leaves out important stakeholders Will it actually align the goals of all agencies? It could be a very long time coming…

How to share information? 3. Integration Facilitators Patient/C lient Family Carers Hospital Specialists Hospital Specialists Charities Community Nurses GP Ambulance Services Ambulance Services A&E Friends Mental Health Mental Health Police Health Services Health Services Social Workers Social Workers Social Services Social Services Multi- Disciplinary Teams Multi- Disciplinary Teams Case Managers Case Managers Community Matrons Community Matrons Primary Care Navigators Primary Care Navigators Benefits A local agency with responsibility for coordinating care on a case-by-case basis Can ensure everyone relevant (including patient/client) has up-to-date information Issues Each agency tends to have a partial ‘reach’ What access do they have to relevant information systems? 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…. Patient/C lient Family Carers Hospital Specialists Hospital Specialists Charities Community Nurses GP Ambulance Services Ambulance Services A&E Friends Mental Health Mental Health Police Health Services Health Services Social Workers Social Workers Social Services Social Services Benefits Accessible to all stakeholders Up-to-date so all know ‘state-of- play’ Technical Opportunities Mobile technology Patient and client information systems? Telehealth and telecare Self-management education and support Issues Read and write access control: who has access to what information? Managing emergent boundaries of team in each case Usability: by clients/patients; by ‘mobile’ care staff etc Who manages/coordinates the system for each patient/client?

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!)