Integrated

My current work is on the Integrated Personal Commissioning (IPC) programme, working for Think Local Act Personal and closely with NHS England.

A natural question to ask is “What’s that?”, and it’s a very good question.

Before answering that, though, I think there are questions we should ask before, such as:

• “What do we mean by ‘integrated’, ‘personal’ and ‘commissioning’?”
• “What difference do each make?”

This is the first of three posts looking at each topic individually (see the introduction to this short series). It’s a very quick way into the issue of integration, sharing information that I’ve found useful in my own learning. It’s not intended in any way to be comprehensive! Thus, if there are things you think should be added feel free to do so in the comments or on Twitter. I’ll update the posts accordingly.

What do we mean by ‘integration’?

It’s perhaps easier to ask the question: “Integration between what?” because there is no one type of integration. Integration could mean:

• Across sectors (e.g. health and social care; health, care and education; health, care and housing etc.)
• Within one sector (e.g. between mental health and physical health)
• Across different levels (e.g. prevention, early intervention, primary, community, secondary and tertiary health services)
• Across providers
• At parts of a process (e.g. single assessment or review).

There is also a question of the extent to which integration happens. So, for example, it’s possible to link things together, co-ordinate things or fully integrate them (see page 15 here (pdf)). Finally, there’s the option of whether integration is “real” (i.e. mergers between organisations or physical assets, such as teams) or “virtual” (i.e. partnerships, alliances or other relationships between organisations).

Since integration can mean a whole host of things in practice, there are various “typologies of integration” that try and capture these. See, for example, Fulop’s typologies of integrated care (p.4) or a discussion of macro, meso and micro levels of integration (pdf). Thus, locating yourself in what type of ‘integration’ is being done is important in the first place.

Useful overviews of what integration is:

• An incredibly useful primer to what integration is is available from the King’s Fund (see slides 6-13)
• “Integrated care” by the King’s Fund (pdf)
• “What is integrated care?” by the Nuffield Trust (pdf)

We most typically associate integration in the current context within integration across health and social care. A 2011 discussion paper from the King’s Fund that covers this topic quite comprehensively is here (pdf). A 2015 article on the same from Richard Humphries is here.

What difference does integration make?

You can fall into this rabbit hole and never emerge, so significant is the literature on the difference (or otherwise) that integration makes. It literally has its own journals (note: plural).

Even so, here are a few of what I’ve found to be the most useful bits of research on the difference integration makes:

• Examples of the impact that integration has had at macro, meso and micro levels (from organisations in the US and beyond who have been doing this for a while) (King’s Fund)
• Findings from 8 projects on integrated and community-based care (Nuffield Trust)
• A review of systematic reviews of the effects of integrated care on quality (International Journal for Quality in Health Care)
• Significant and detailed report on the difference different ways of integrating (care co-ordination in networked or integrated organisations) makes from a person’s point of view (see page xxii for easy summary) (NIHR)
• A review of evidence to date on the integration of funds for health and social care (Journal of Health Services, Research & Policy).

Finally, from a policy point of view, it’s worth noting National Voices’ “Principles of Integrated Care” and the continuing Shared Commitment to Integrated Care.

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