Guest editorial: Integrated services for older people – the key to unlock our health and care services and improve the quality of care?

Abstract

Across the United Kingdom, there is growing interest from politicians, national and local service leaders and clinicians in integration, care co-ordination and partnership working (Curry and Ham, 2010; Goodwin et al., 2013b; Ham et al., 2011, 2013; NHS Confederation and Royal College of General Practitioners, 2013). Some specific policy levers and targeted funds and financial instruments have aimed to facilitate integration and make it the norm rather than the exception (Bennett and Humphries, 2013; Royal College of Nursing, 2014). There is a tacit assumption that a shift towards these models will be ‘‘win/win’’ – improving care for individual service users, whilst also saving services from the ‘‘triple threat’’ of population demographics, rising demand and financial austerity (Naylor et al., 2013). Influential health think tanks the King’s Fund and Nuffield Trust (Goodwin et al., 2013a) and professional Bodies such as the Royal Colleges of Physicians (RCP, 2013), General Practitioners (RCGP, 2014) and Nursing (RCN, 2014) have focused increasing efforts on the cause of integration. Whilst my editorial focuses on the UK, other health systems facing similar challenges are increasingly embracing the same agenda (Goodwin et al., 2013a, 2013b, 2014; Ham 2011, Timmins and Ham, 2013). I won’t get drawn into endless, abstruse definitions of what we mean by integrated services. There is a body of literature for those with a niche interest in terminology or who like to close down discussion by saying ‘‘everyone’s talking about it, but no-one can agree what it is’’. I am more concerned by how integration might help support people in need of health and social care and improve their experience and outcomes. We can return to definitions later. Let’s start ‘‘bottom up’’ with people before worrying ‘‘top down’’ about structure and process.