Miller Robin, Glasby Jon, Dickinson Helen
University of Birmingham, UK.
University of New South Wales, Australia.
Int J Integr Care. 2021 Oct 29;21(4):6. doi: 10.5334/ijic.5666. eCollection 2021 Oct-Dec.
As part of major policy reforms begun in 2010, England introduced a wave of initiatives to encourage more integrated care between health and social care. These built on previous attempts which sought to achieve similar objectives through a focus on better partnership working. This article provides an overview and critical commentary on integrated care policy in England from 2010-2020 based on reviews by regulators, parliamentary committees and the national audit office.
Integrated care became a priority through the work of the Future Forum, a group of leading stakeholders established due to concerns about greater competition in public health care. This led to a public statement of shared commitment to integrated care by national health and social care bodies. Early mechanisms included a pooled fund to achieve nationally set objectives, the creation of local authority led partnership boards, and high profile innovation programmes. Later in the 2010's, new health led partnerships became more dominant vehicles to achieve integrated care at regional level.
Despite progress within a few local areas, and reduction in delayed discharges from hospital the overall picture from national reviews was that expected improvements were not achieved. Emergency admissions to hospital continued to grow, patients within primary care reported being less involved in their care, and health inequalities worsened. The initial response to COVID-19 was health-centric contributing to outbreaks in care homes and inadequate supplies of protective personal equipment. The ability of leaders to look beyond their organisations' interests was reported as vital for local progress. National government performance frameworks discouraged system based working and chronic underfunding of social care led to major capacity and workforce challenges.
The experience of England suggests that greatest progress is made when integrated care focusses on tangible issues and when there is a clear understanding of how success will be measured. Even with considerable investment and intent progress should be expected to be slow and difficult. Layering of numerous policy initiatives provides confusion and can distract from the important work of relationship building. And ultimately, integrated care cannot by itself address major inadequacies in the underlying resources and structural inequalities.
作为2010年开始的重大政策改革的一部分，英格兰发起了一系列举措，以鼓励医疗保健和社会护理之间实现更综合的服务。这些举措建立在以往通过专注于改善合作关系来实现类似目标的尝试基础之上。本文基于监管机构、议会委员会和国家审计署的审查，对2010年至2020年英格兰的综合护理政策进行概述和批判性评论。
通过未来论坛的工作，综合护理成为一项优先事项。未来论坛是一群主要利益相关者组成的团体，成立的原因是担心公共医疗保健领域竞争加剧。这导致国家医疗和社会护理机构发表了一份关于对综合护理共同承诺的公开声明。早期机制包括一个用于实现国家设定目标的统筹基金、设立由地方当局主导的合作委员会以及备受瞩目的创新计划。在2010年代后期，新的以医疗为主导的合作关系成为在区域层面实现综合护理的更主要方式。
尽管在一些地方取得了进展，医院延迟出院的情况有所减少，但国家审查的总体情况是，预期的改善并未实现。医院的急诊入院人数持续增加，基层医疗中的患者报告称较少参与自身护理，健康不平等现象加剧。对新冠疫情的最初应对以医疗为中心，导致养老院爆发疫情以及个人防护装备供应不足。据报告，领导者超越其组织利益的能力对地方进展至关重要。国家政府的绩效框架不利于基于系统的工作方式，社会护理长期资金不足导致了重大的能力和劳动力挑战。
英格兰的经验表明，当综合护理专注于切实问题且清楚了解如何衡量成功时，取得的进展最大。即使有大量投资和意愿，进展预计仍将缓慢且艰难。众多政策举措的叠加造成混乱，可能会分散建立关系这一重要工作的注意力。最终，综合护理本身无法解决基础资源和结构性不平等方面的重大不足。
