Helen Salisbury: Do we need integration?BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4614 (Published 16 July 2019) Cite this as: BMJ 2019;366:l4614
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There is very little rationale for more "integration" in the NHS and even the choice of word reflects an error in understanding what the problem is.
When we talk "integration" we automatically think of removing the barriers among separate organisations. But this seems to assume that the reason why patients don't get coordinated care is because organisational boundaries are a big barrier to coordination. This is a serious and misleading error.
Most people already know examples of why that is so. If the big barriers to coordination of care were external, then care inside big single NHS organisations like major hospitals would be smooth and well-coordinated. It isn't. Most hospitals can't even organise coordination between their pharmacies and their discharge teams (eg delays to take home prescriptions and drugs often add long delays to discharges).
The biggest, most harmful, barriers to coordinated care are operational not organisational. To assume–as the drive for more "integration" seems to do–that merging organisations will improve coordination is not just wrong it is actively harmful as it diverts scarce management talent away from operational improvement and into futile organisational restructuring.
If the the NHS were right that integration is required for coordination the world would look very different. Only EE customers would be able to call BT landlines from their mobile phone. Nobody would be able to call a friend on a different network. The internet would not work and Apple customers would not be able to use services built on Android or Microsoft systems.
The rest of the economy is based on even competitors working out how to make their competing system work smoothly together despite their organisations being competitors.
The NHS is actively pursuing a goal which is not just wrong but harmful.
Competing interests: No competing interests