Integrated Care: Some unexpected frustrations of research in the NHS

24 Jan

by Jonathan Stokes, PhD student in Multimorbidity theme


I’ve recently started my PhD at the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre in the Multimorbidity theme. My project plans to look at case studies of models of integrated care being piloted in the NHS at present.

Integrated care is quite a loosely defined idea. One review found over 175 different definitions… Basically, it boils down to the better linking of various aspects of health/social care, so that the patient experiences a more coordinated, efficient and effective service.

Despite there being no consensus definition, and only limited evidence of effectiveness of any specific models of integrated care, high-level policy makers are heavily pushing for the implementation in England (and worldwide). There seems to be an inherent good seen in the idea of ‘integration’, after-all the opposite is fragmentation. Not only this, but there is a clear logic in pushing for integration when we consider the evolving case-mix health systems are facing globally.

We are seeing worldwide an ageing population with a shift in the diseases encountered towards patients with multiple (hence the term multimorbidity), long-term, chronic conditions (e.g. cancer), instead of the main burden being acute conditions (e.g. malaria infection – conditions which of course remain a huge burden in the developing world) as was historically the case. This new burden requires a different mode of treatment than our health systems have evolved to offer.

These patients with multimorbidities often require treatment from a number of different specialists, often in a variety of locations at different times. As it stands, this fragmentation in the working of the health system is an obvious safety concern. Patients need to explain their medical problems to each new health professional they see, often assuming the professional knows their general case history (which they usually don’t thanks to a lack of medical record linkage in most places…), as well as the safety issues of someone who is frail travelling to the multiple appointments in the first place.

Better coordination of services for these patients then, should of course solve obvious opportunities for harm to come to a patient as they fall through the gaps between services.

My project then, aims to provide evidence for which real-life models of integrated care, being trialled all over the country at present, work most effectively.

Unfortunately I am already facing some frustrations in doing so, from a source I really didn’t expect to find these when studying in the NHS setting (I’ve come from studying mostly international health systems): It is not easy to find out what is being commissioned by each locality in the country!

This lack of transparency really makes it difficult to look at things at a systems level, and so to effectively use the rich data source available in primary care in this country. It’s a real shame that the NHS have failed to manage this data in a usable way for researchers like myself. This frustration has in fact led me to my first piece of work which I hope will expose this lack of transparency in the system, and while doing so, will hopefully give me a better perspective of what the state of integrated care in our country actually is. Hopefully, by starting here we can begin to learn what in fact works best for those who need it.

Watch this space…

One Response to “Integrated Care: Some unexpected frustrations of research in the NHS”


  1. Evolving research for multimorbidity | dukejonny - February 4, 2014

    […] cases. This is well recognised, and integrated care (which I have spoken about in another of my blogs) is an attempt to re-orientate the system towards treating patients with […]

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