Opinion Article: People, Politics and Personalities - How Changing Attitudes is the Final Step to Integrated Care

By Andy Clegg, Clinical Specialist, Orion Health
Integrating health and social care has been on the national agenda for over 20 years and despite the introduction of various policies, strategies and initiatives to deliver it, we are still not there yet. The well-documented drivers for joining up health and social care, such as capacity issues in acute hospitals and people living longer, is resulting in a situation which is unsustainable, meaning the way we deliver care should change in a radical way.

Encouragingly we are seeing adjustments to the way colleagues in and out of the NHS are addressing these issues - non-acute providers such as community pharmacies are expanding their remits to help to ease inpatient pressures in hospitals and care professionals are able to manage their relationships with patient groups in the community with the support of service redesigns and new technologies.

The focus on delivering integrated care has so far been on the 'hard' elements such as reorganisation, commissioning, performance and regulation. In fact, Chris Ham, chief executive of The King's Fund recently blogged about the barriers to integrated care identifying these elements as priorities.

However one important factor was missing, the most important in my view, and that is the attitudes of people - from clinicians to management and nurses to GPs - involved in delivering care.

A different mindset
People throughout healthcare are now more receptive to change than ever before. Why? Because they recognise that the way we work and interact with colleagues within and across different organisations has to change in order to achieve the vision for integrated care.

Take the example set by Canterbury District Health Board in New Zealand in the wake of Christchurch's devastating earthquake in 2011, which accelerated their plans for joining up health and social care.

In the face of adversity, a 'can-do' culture was embraced in order to deliver integrated care in rapid time. Initiatives were led by staff, rather than imposed by management, resulting in scenarios whereby health pathways were drawn up by hospital specialists and GPs working together, agreeing best practice on a local level.

Politics and personalities
Here in England, health and social care professionals at all levels are being asked to form and build relationships, working together for the greater good. But this does not always happen naturally and sometimes personal politics gets in the way, making it hard to pull in the same direction.

Leaders are often defined by their strong personalities. Problems can occur if you enforce a working relationship between two leaders, say one from a local authority and one from a local community health organisation who have differences in opinions or philosophies - it can actually become very difficult to progress with the task in hand.

But leaders also see the bigger picture and this is vital for integrated care. I remember two heads of IT in the Midlands working together as a result of their respective trusts merging. Both had very different approaches and had every reason to conflict rather than co-operate but they quickly established that by using each other’s experience and skills they could achieve much more together than individually.

The final step
The many changes going on throughout the NHS including the transparency of provider performance, heavier scrutiny of regulation and the introduction of new legislation leads to a fear of the unknown for many care professionals. That fear often results in defensiveness and resentment amongst workforces, fertilising unproductive blame cultures and a reluctance to cooperate.

The future is about our ability to harness relationships to overcome that fear. If there is a willingness from people to tackle future challenges together then we will have a much better chance of achieving our goals. Integrated care needs people to make it happen - everything else you can get past.

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