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The role of respiratory services in integrated care

Integrated care opinion piece by David Brindle

Thursday, November 22, 2018

Integration remains the elusive holy grail of the health and care system. Reducing demand for treatment through better integration and prevention is one of the five rules underpinning the imminent NHS plan, which will chart a 10-year course for change. But it’s something observed – at least so far – more in ambition than in practice.

Can respiratory services show a lead? It’s an intriguing thought, and one we shall test at the Respiratory Futures panel debate at the BTS Winter Meeting when the proposition will be: “Can integration reboot the nation’s lung health?” On both counts, there are grounds for optimism.

Few other specialties have the same ingredients in place, or quite the same pressing urgency to stem the spiralling number of hospital admissions, as has respiratory care. This could be its moment.
David Brindle

The conventional, perhaps cynical, view of integration in health and care is rather like Gandhi’s celebrated comment on western civilisation: yes, it would be a good idea. The latest, faintly despairing verdict came in a report by the Commons Public Accounts Committee in October. While there were examples of successful integrated working across England, the report said, there remained “a range of longstanding legal, structural and cultural barriers hindering the pace and scale at which change can happen”.

Within the NHS, some of the biggest barriers can be professional. The divide between respiratory specialists and teams operating in primary care is too often a real hindrance to people’s ability to manage their own condition. But it is true also that inflexible commissioning arrangements may discourage specialists from applying their skills beyond hospital walls.

Reducing demand for treatment through better integration and prevention is one of the five rules underpinning the imminent NHS plan, which will chart a 10-year course for change.
David Brindle

The Respiratory Futures web portal pulls together some of the best examples of such obstacles being overcome, but it also now offers a mine of information – arguably without parallel in any other clinical field – of the intentions of each of England’s 44 sustainability and transformation partnerships (STPs) to bring respiratory services closer to people’s homes.

Key to this goal will be the development by NHS England of integrated care systems (ICSs), formerly termed “accountable care systems” but rebadged to make them sound less like the American accountable care organisations from which they are drawn. Mike Morgan, national clinical director for respiratory services, thinks these innovative approaches to population health improvement have the potential to lead a breakthrough on effective implementation of the NHS RightCare COPD Pathway – and he could be right.

Few other specialties have the same ingredients in place, or quite the same pressing urgency to stem the spiralling number of hospital admissions, as has respiratory care. This could be its moment. As Morgan says: “Respiratory disease is a great place for integrated care systems to start, and offers a massive opportunity to make a real difference to patients.”

 

David Brindle is the Guardian’s public services editor

David is chairing the Respiratory Futures panel debate at the BTS Winter Meeting 2018: can integration reboot the nation’s lung health? Thursday 6th December, 10.30-11.45am, Gielgud, 2nd floor. Find out more here.