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Integration isn’t enough
Martin Routledge
Individual level integration
• Integration now central to health and social care
policy
• But most attention is paid to structural and service
integration
• Vital to explore integration at the level of and
directed by the individual
• Self-management and health and social care
personal budgets can play an important role,
especially with long term conditions and “wicked
issues”
Kings Fund model for older people
Oliver, Foot and Humphries 2014
Control as well as co-ordination
Better use of shared resources
Effective interventions
Co-ordinated professional support
Care in people’s own homes and communities
Good planning with individuals and families
Support for self-care and management
Information about options and choices
People exercising control over their
care
Co-production – a win-win
Personal health budgets evaluation
replicates research in social care:
•Better well-being outcomes for people with
LTCs, reduced use of hospital, cost effective
especially for people with the highest needs
•Best results achieved when: people know £ up
front; advice and support available; choice and
flexibility over how to spend budget , choice on
how it is managed
To share power we will need to:
1. Drive co-production into all areas of commissioning and
delivery of key local services
2. Measure the things that are important to users of key public
services and use the results to drive local developments
3. Lever and incentivise new or currently marginal forms of
care and support
4. Drive integrated personal budgets with a strong focus on
those areas which would be of major benefit for people
using them while helping to address significant system
financial challenges or "wicked issues
5. Lever and support the re-targeted use of professional skills
and capacity
Consensus?
• People are often the best integrators of their
own care and support : Norman Lamb
October 2013
• People are active citizens, with whom power
and responsibility must be individually and
collectively shared: Liz Kendal March 2014