How do we humanise integrated care?
27 January 2020
Bev Fitzsimons considers the challenges and opportunities of working with Integrated Care Systems
Our work at the Point of Care Foundation has always been driven by our wish to see a health system that puts patients at its heart. Much of our Sweeney programme’s work has focused on individual NHS organisations, supporting teams to see care through the eyes of patients, whilst we support the people who provide care to give their best by helping organisations to embed Schwartz Rounds.
It’s a model we know works – making a difference to thousands of health workers, and through them, many times more patients – so we will continue to use it. However, over the last several years a major shift has begun to occur as health and social care services have started to integrate. This is a challenge we have to address.
There is a clear logic to the integration of health and care services, as a growing, ageing population, living longer with more long-term conditions, requires high-quality care. The challenges this creates manifest in all sorts of ways throughout the health and care system. To take just one well-known pinch point as an example, the acute pressures felt by hospitals are being compounded by the need to discharge patients who are often too well to be in hospital, but not well enough to leave the building without a care package in place. This requires close alignment with other care services, which are also under severe strain, and this can cause delays, adding to pressures within the system.
In 2016 the NHS sought to tackle these dislocations by instigating Sustainability and Transformation Plans (later Partnerships) across the English NHS, to develop services to meet local need more effectively. Some of these developed further into Integrated Care Systems, charged with coordinating care delivery across NHS, local government and other care organisations. Now, under the NHS Long Term Plan, all parts of England are set to be covered by an Integrated Care System by 2021.
In this context, we needed to think differently about how we can most effectively support services to deliver patient-centred care. Our experience with Schwartz Rounds has shown that there are a number of organisations outside of the traditional health sphere that benefit from using Rounds to support staff and build understanding and compassion into their culture. With the arrival of the first Integrated Care Systems, we believe that our programmes for patient-centred quality improvement and support of staff can be effective in this new, integrated environment.
This was put to the test last year when we worked with the Dorset ICS (Our Dorset) who recognised the opportunity for placing patients at the heart of their health and care system, by building capacity within their young organisation to foster this approach across its services.
For us this meant thinking differently – working strategically with senior leadership as well as staff delivering at the coalface. In an integrated care setting, our focus needs to be wider than a particular service or team, to capture people from across the system and build capacity to engage with patients and communities to make services better. For example, in Dorset we worked with people from housing and environmental services, the voluntary sector, and various health professionals. While all of them shared a passion for working together to achieve the best possible outcomes for the people using their services, moving to a new way of working can cause anxiety. We provided practical learning to build confidence, enabling people to see close up how taking an experience-based approach can make a difference to care quality. This often resulted in a high level of commitment to shaping services to suit users’ experiences.
Because we know that compassionate care, in whatever setting, can only be provided by staff who themselves feel supported, we want to couple the practical training of our Sweeney methodologies with Schwartz Rounds. The cultural impact of Schwartz Rounds – building understanding across teams within an organisation and helping people recognise their shared experiences – seems particularly important within an ICS, which may host a wide range of practitioners and can exist in a context of organisations being merged or having to work together for the first time..
Over the next few months we will share more about our experience of working in the integrated care context. It is important that patient-centred, humanised care becomes as integral to an ICS as it is to an individual organisation or healthcare team.