Joined up thinking?

There has always been plenty to argue about in the NHS. Amidst all the uncertainty that a New Year brings of one thing we can be sure – this won’t change in 2013. Indeed, as the latest NHS reforms become reality on 1st April 2013, expect more heat and not necessarily more light.

What has struck me, however, is the amount of consensus that is seemingly building on the subject of Integrated Care.

Sure there are shades of grey – probably more than fifty – but on the central premise of ‘is it a good thing?’ there would appear to be general agreement.

Whisper it, but I have even seen it written that “Integrated care is now a recognized paradigm for health care reforms around the globe.” 1

The health commentariat also appear to agree that to do integrated care properly you need the data. Importantly this data needs to be joined up. Commissioning intelligence should be based on connected data and such data should be at the heart of the integration of health and social care.

Two recent articles in the Health Service Journal (HSJ) are worthy of mention. In ‘Lessons from Boston on Integrated Care’ (published 9th January), Pam Garside talks about the “relentless use of data” by those involved in integrated care in Boston. She also talks about “the burgeoning opportunity to absorb data from multiple sources to the benefit of individuals and populations.”

In ‘The building blocks for integrated care’ (also published in HSJ on January 9th), Rob Beardall writes about the importance of data being integrated across organisational boundaries. He states, “This shared data – effectively an electronic patient record – must be based on a single repository that allows complex decision logic to look across boundaries and identify gaps in care.”

In an NHS Confederation/RCGP report published before Christmas last year, titled ‘Making integrated out-of-hospital care a reality’ 2, I was particularly encouraged to see Johns Hopkins Adjusted Clinical Groups® (ACGs®) getting name checked. ACGs are specifically referenced as how organisations can use risk profiling systems to help identify those who should gain the most from an integrated care system. ACGs provide insight when run against joined up data.

So that’s good then …

Joined up data.

We are all agreed …

Joined up thinking.

So if this is the case; why, then, has all this proved so difficult to achieve?

It is tempting to look to the past and embark on a forensic analysis of the reasons for failure – NPfIT anyone? The result: naval gazing, hair shirts and more time lost.

Rather than agonise over past failings and opportunities missed, better surely to look to the future and design integrated solutions that address the problems of the ‘here and now’.

In terms of the data integration piece, there is no shortage of willing players. The NHS Information Centre (NHS IC) wants to do it. Newly created Data Management Integration Centres (DMICs) want to do it. Commissioning Support Units (CSUs) want to do it. Some Clinical Commissioning Groups (CCGs) may want to do it. The Private Sector certainly wants to do it and have I mentioned educated bees yet?

Importantly, if the patient is truly to be at the heart of the new commissioning paradigm, then the data needs to be joined up at a patient level.

It’s not as if we need a whole new tranche of NHS data sets to provide the insights required. We just need to make the existing ones work for us.

Furthermore when designing solutions we need to be cognisant of the new agenda for CCGs, which is concerned with localism. The clinicians who are going to make this happen operate at a local level, serving citizens and patients who live locally. The new system creates an environment where clinical leaders operate under assumed liberty.

Please, spare us from further dictacts from ‘mission control’.

Liberate (verb) 1. To give liberty to; make free

And yet, whilst everyone seems to argue that data is on the whole a good thing and intelligence is a pre–requisite to insight and better decision making, the reality on the ground is that battles still rage around data sharing agreements and information governance (IG).

A lot of talking, far less walking.

I understand the issues around patient confidentiality and IG. Honestly I do. But it occurs to me that the time has come for a mature debate around risks and rewards.

Of course the release of personal details into the public domain can damage lives and should never be tolerated. There are, however, also huge risks to entire populations of not linking the data at a patient level and not making it available to healthcare professionals who can make things better.

How many citizens and patients currently carrying long term conditions are receiving sub-optimal care as a result of the absence of connected NHS data sets and an integrated health and social care record?

As I say, the arguments will continue well into 2013 and beyond.

But at least we all agree that integrated care is a good thing and that integrated data and the relentless application of that data to secure better understanding and better healthcare outcomes is actually unarguable …

… don’t we?

[1] International Journal of Integrated Care – Nick Goodwin & Lourdes Ferrer (December 2012)

[2] Making integrated out–of–hospital care a reality / Royal College of General Practitioners and NHS Confederation (December 2012)–out–of–hospital–care–reality.aspx