Why care about integrated care? Part I. Demographics, finances and workforce: immovable objects facing mental health services

Abstract

SUMMARY Demands on health and social care are growing in quantity and complexity, with resources and staffing not projected to match this. The landmark NHS Long Term Plan calls for services in England to be delivered differently through integrated care systems (ICSs) that will better join commissioners and providers, and health and social care. The scale of these changes is immense, and the detail can feel confusing. However, they are important and will affect all clinicians in the public service. This three-part series provides a primer on integrated care, explaining why it is happening, how services are changing and why clinicians should get involved. In this first article we focus on the changing demographics, and the workforce and financial resources required to address these.

Why care about integrated care? Part 3. Weighing sunlight: delivering integration in practice and measuring success

“…In part 1 (Tracy 2020a) we noted the King's Fund's four pillars of a true population health system as: integrated health and social care; places and communities we live in; our health behaviours and lifestyles; and wider determinants of health such as income, environment and education (Buck 2018). Clearly, even an optimally funded and functioning integrated health and social care system – and none of us have one of those – is thus limited in what it can achieve.…”

“…This will apply for both ‘true’ need (e.g. in part 1 we noted how only a minority with a mental illness received any care at all; Tracy 2020a) and ‘false’ or inappropriate need (e.g. a district nurse picks up a possible case of mild depression in someone whose wound dressing they were changing and books the person into a consultant psychiatry clinic).…”

Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services

“…For example, perhaps two-thirds of improvements in cardiovascular disease are from tackling hypercholesterolaemia, hypertension and smoking, with only one-third from direct treatment (Capewell 2011). In part 1 (Tracy 2020a) we noted the limitations of even an optimally funded healthcare service in tackling such factors alone.…”

Time to get serious about distributed leadership: lessons to learn for promoting leadership development for non-consultant career grade doctors in the UK

“…The COVID-19 pandemic increased healthcare demand, including rapidly changing novel clinical needs, at a time when organisations were already struggling with limited resources, and a workforce recruitment and retention crisis. 1 Because of this, leadership had to adapt quickly and innovate as routine services were cancelled or altered; 2 while the increase in sickness rates, staff quarantining and social distancing meant that there were far fewer social supports for everyone, including for those at the frontline. 3 The pandemic emphasised the importance of staff well-being 4 and of flexible, emotionally intelligent and better distributed diversity of leadership.…”