Feature Integrated Care

Financial benefits of integration: a case of wishful thinking?

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3661 (Published 03 June 2014) Cite this as: BMJ 2014;348:g3661
  1. Richard Vize, freelance journalist
  1. 1London, UK
  1. richard.vize{at}gmail.com

Billions are about to be spent on integrated care with the aim of enabling the NHS to do more with less in future. But, although there is evidence that patients benefit, Richard Vize finds it is far from clear that integrating care will ever save money

The case for integrating care has been compelling. It seems obvious that health and social care services should be working more closely together to provide better care, meet rising demand, and cut costs in wasted or duplicated efforts. It is the much needed shift in care provision that people have been talking about for 20 years. But evidence that integration works is hard to find. Does it justify the time and money being spent?

Integrated care is an imprecise term. It is often used to describe the coordination of existing services, perhaps extending to pooling budgets or sharing staff. But Merav Dover, chief officer for Southwark and Lambeth Integrated Care in south London––says: “Don’t confuse integration with just joining up—it’s a completely different approach and model of care.

“You have to look at your entire services and change them,” says Dover, who works with King’s College Hospital and Maudsley and Guy’s and St Thomas’ foundation trusts, Lambeth and Southwark clinical commissioning groups (CCGs), councils, and general practitioners. “You cannot do this as an add-on. You have to change the way everybody’s working so that it’s mainstream, not an improvement project that is added on. Only when it’s mainstream in that way will we really see the results in the measurements.”

The aim, she says, is to deliver a “social model of care” built around prevention, early intervention, and community services for long term conditions. The government’s Better Care Fund, created to fund integration, has allocated £3.8bn (€4.7bn; $6.4bn) for integrating health and social care …

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