Dr Elizabeth Kendrick is a GPwSI for older people and National Professional Advisor for older people for the Care Quality Commission. For further information please contact elizabeth.kendrick@cqc.org.uk
CQC has begun a review that explores how health and social care services currently work together to deliver care for older people that is integrated.
Our health and care system is complex. There is some outstanding care in the system and there is also inadequate care. However the problems experienced by patients particularly the most vulnerable such as frail older people are often at the transfers of care between organisations.
We want to show what good integrated care looks like: what people should expect from it, how it can be commissioned and how its success can be measured.
CQC’s review will identify barriers to the delivery of integrated care and it will highlight good practice. Based upon our findings and to help improve older people’s experiences in care, we will propose actions for providers and commissioners. Older people’s care is too often fragmented and episodic. It often happens around the needs of organisations rather than the needs of the person and this review will aim to address that.
The findings of this review will help us design future models of regulation, focused on pathways of care for the individual, rather than the providers. This will help us respond to new models of care.
In carrying out this review, CQC is interested in people’s individual experience of care, as well as data which describes how people interact with – and move between – different organisations in the health and care system. We will be using case tracking, pathway tracking, interviews with patients, their carers and professionals. We will also be looking at medication management and care plans. We are also requesting information from commissioners of health and social care, under legal powers granted by the secretary of state.
Fieldwork for this review will take place across 8 health and well being boards across England between October 2015 and December 2015. The sites include: Wakefield, Stockton on Tees, Cambridgeshire, Mid- Bedfordshire, Camden, Hammersmith and Fulham, Bristol and Portsmouth. A national report will be published in Spring 2016.
Image credit: Horia Varlan via flickr.
British Geriatrics Society 
It’s great to see CQC being even more creative and innovative in looking at this level of integration. Having worked in integrated teams, I’ve experienced the different occupations creating their own space and having their own seats. I have also seen teams be dismantled as they have worked only in part.
Differences in ‘uniform, status, salary and methods’ have all helped to scupper ‘working well together’.
A radical approach is required that successive Governments have looked but have chosen not to take the risk. One health, social care and housing organisation would takes a decade or more to bed in but in order to get something different, we need to do something different. The same old, same old will produce the ‘same old’.
I offer two contributions to he issue of integrated care:
1. The value of one person based close to the patient and able to relate to necessary care providers and interpret, coordinate and courage them in the interests of the patient. One person is not a team or a system, but a single focus. I was able to do that as a palliative care physician, available to patient and family whether in hospital, aged care facility or home; my mobile number always avau,able, rarely called unnecessarily. The family practice can do this.
2″ the patient-held record, In 1963 I worked in Mulago hospital, Uganda. Mothers of small children presented to the clinic, reached down into substantial bosums, and brought our a small bundle of papers on which previous health advisors had written assessments and treatments. After the consultation Inadded my own message and the bundle disappeared into the same depth to be available for any future medical visit.
Lots of current interest in IT solutions; don’t forget simple measures.
Ian Maddocks, Australia