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How can the NHS deliver integrated care?

Sue Thomas and Paul Midgley, of Wilmington Healthcare, explain the changes needed to help the NHS provide a more holistic, joined up experience for patients

The Five Year Forward View (5YFV) aims to develop new, integrated, cost efficient models of care that will provide a more joined up experience for patients. But how can we move away from an NHS service that is fragmented and often poorly co-ordinated to one that puts the needs and experiences of people at the heart of service organisation and delivery?

NHS vanguards – which have been tasked with developing new models of care as part of the 5YFV – are already demonstrating the variety of ways in which integration can be achieved from joining up GP, hospital, community and mental health services to integrating IT systems within a particular specialism across a region.

Indeed, the sheer variety of projects being undertaken by vanguards helps to explain why integration means different things to different people and that unless planned changes are clearly communicated to stakeholders, misconceptions about what is being proposed can be a huge barrier to change.

Consequently, making smaller changes and introducing them from the bottom up, rather than the top down, can be a more effective way of getting key stakeholders, including clinicians, on board and making change happen.  

When services are redesigned through integration, it is important to manage patients across the whole pathway of that condition from diagnosis to end of life care, rather than focussing on individual elements of care or disease stage. To achieve this, we need to outline the support needed from both a patient and professional perspective across the continuum of the disease in health and social care, map needs in line with NICE guidelines, if available, and provide an end to end service pathway.

The Health Management Organisation (HMO) style of management could be a useful area for pharma to consider in the future with pre-symptom identification, early detection and proactive lifetime management by an HMO  

However, in addition to HMOs, the NHS also needs to consider - and potentially provide more specially trained staff - to tackle co-morbidity issues and the complex health needs of the nation’s ageing population.  

Harnessing the experience and knowledge of patients, carers and health and social care professionals is vital when changing patient pathways through integration. Indeed, there is strong evidence that effective communication and engagement with patients, carers, the public and other stakeholders helps to improve commissioning decisions, patient satisfaction and service use.  

To obtain this feedback, we need to get patients to tell us their experiences of their current care - is it good or bad? If we then process map their experiences, we can use a shared decision making process to identify what the best outcomes for them would be and implement them. We can gather this kind of information via face-to-face discussions; online questionnaires; videos; focus groups and participation in events for patients.  

Understanding how services function is key to integrating NHS services and improving patient pathways, and pharma can help in this regard by utilising and interpreting data. This can help to identify issues that need to be addressed and highlight opportunities to improve patient outcomes and create efficiencies.  

For pharma, this might mean initially utilising the RightCare Commissioning for Value packs to identify where there is unwanted variation in NHS services. Pharma can support organisational change through mutually beneficial partnerships with the NHS.  

In conclusion, the NHS needs to review many of its care pathways to ensure patients, carers and families have a meaningful say in how services are delivered but current pressures often prevent this happening. Pharma has a real opportunity for engagement here and should grasp the nettle now.    


Sue Thomas is CEO of the Commissioning Excellence Directorate and Paul Midgley is director of NHS insight, both at Wilmington Healthcare. For information on Wilmington Healthcare, log on to

19th December 2016



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Wilmington Healthcare

01268 495600

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United Kingdom

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