There are three reasons for the challenges we face in healthcare: demographic change, need for cost containment and citizen empowerment. The demographic change is the unprecedented high proportion of older people in society, especially those living in single-person households, which puts demand on all healthcare services. As the number of older people rises, the supply of caregivers is at risk.
The rise in health expenditure and the future of pensions is at stake. Costs need to be contained. Financial sustainability of health and social care delivery systems is an issue frequently debated among NHS leaders.
Finally, the era of compliant citizens is drawing to a close and in its place we have people across all age groups who demand choice and healthcare interventions to meet their needs. They also call for full accountability of services with professionals increasingly subject to CQC and Monitor jurisdictions, and clients claiming their legal rights.
Integrated care provides one answer to these challenges. Integrated care promises to tackle the problems of the most needy in our population – complex older people and complex children. Both these groups have long-term, complex and multiple needs but are seen in terms of their differences not their similarities. People in these groups require a different approach to traditional or usual care delivery: a tailored package of care and services covering multiple domains of life, as well healthcare providers that pay attention to their preferences and responsibilities. These groups are often faced with complex problems which span across physical, mental and social domains. Through integrated responses timely detection, appropriate assessment, treatment and care we can – at least partly – prevent the negative outcomes on health and wellbeing.
Providing appropriate family-centric packages of care and services at the appropriate time and as close to home as possible contributes to people's wellbeing, in spite of age, frailty and disabilities. Furthermore, having autonomy and responsibility will contribute to their resilience and subsequently their quality of life. Integrated care deals will help empower younger and older people to live better lives.
Caring is a discipline of human relations. The key to integrated care is to ensure that these relationships function at their optimum. It is a challenge to healthcare providers and policy makers to design, fund and deliver such care. There are many obstacles in our current healthcare models and service delivery systems, as well as in traditional management styles. However, with the emergence of new transformational policy drivers like the NHS 5 Year Forward View we have the opportunity to design and establish well integrated services where they are most needed. Nursing as a profession must take a first step and establish a body of knowledge on a national UK nursing model to deliver integrated care for younger and older people.
Marina Lupari is the primary care nursing lead at the RCN