What is integrated care?
There are many definitions of integrated care, and the RCP supports the National Voices’ definition:
I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.
At the heart of integrated care is the principle that people should be equal partners in their care. Teams from across the health and social care system should work together to deliver joined-up care, coordinated around people’s physical, psychological and social needs.
This can be achieved through:
- horizontal integration, which focuses on competing or collaborating organisations, networks or groups in the health economy and might involve, for instance, grouping outpatient clinics within a geographic network of providers
- vertical integration, which focuses on networks and groups at different stages of care within the health economy and might involve, for instance, drawing together a hospital with local community services
- physical integration, such as primary care sitting in emergency departments
- virtual integration, where geriatricians, GPs and community services hold virtual wards.
Why do we need integrated care?
People benefit from care that is person-centred and coordinated within healthcare settings, across mental and physical health, and across health and social care. For care to be integrated, organisations and care professionals need to bring together all the different elements of care that a person needs.
This is particularly important when care is provided by different providers and healthcare professionals. A lack of integration can lead to care that is fragmented, delayed, duplicated, and not based around a person needs. This can lead to patients and carers feeling lost and unsupported when they need care most.
Delivering integrated care is essential to improving outcomes for people who use health services.
Delivering integrated care in your service
When designing and delivering services, the following principles should apply:
- everyone is supported to lead a healthier life
- people’s basic care needs are always met
- people’s experience of care is valued
- know who is responsible for their care
- are actively involved in decisions about their care, and their families and carers are supported as partners in care
- are supported to self-care and self-manage
- have timely access to safe, appropriate and effective care, 7 days a week
- receive coordinated services tailored to their needs and preferences
- receive care in settings that best their meet medical and support needs
- have an individual care plan focused on recovery or wishes at end of life
- staff are supported to care, collaborate, improve and lead.
Delivering integrated care on the ground
When planning a service, it is important to consider how it will interact with other parts of the health and social care system. This could include with other medical specialties, particularly for patients with comorbidities, out-of-hospital services such as social care and referral pathways from primary care. You should also consider how you can work with patients to design services that reflect their needs.
There are a range of toolkits and practical resources to support delivering more integrated services and there are an increasing number of examples of integrated care being delivered across the NHS. These can be found at:
- King’s Fund Integrated care hub
- Better Care Fund Toolkit
- North West London Whole System Care Integrated care toolkit
- Monitor’s guidance on delivering better integrated care
- Royal College of Physicians’ Future Hospital Programme development sites
- NHS England’s integrated primary and acute care systems vanguards
- Royal College of Physicians’ review of integrated care.