The Integrated Care Challenge

Today, our health and care systems are faced with the challenge to provide sustainable and cost-efficient services to a growing population who is living longer with complex care needs. At the same time, patients are surrounded by uncoordinated services related to diagnosis, treatment, care, rehabilitation and health promotion – each, in most settings, separately organised, delivered and recorded by organisations and their staff who are separately funded, managed and regulated. This fragmentation of health and care services is particularly detrimental for patients with chronic or multi-morbid conditions who need long-term treatment and often also mental health and/or functional support. Illnesses are treated episode-wise and conditions are constantly reassessed, increasing not only the costs of care but negatively affecting patients’ wellbeing as they have to stay in the hospital for longer rather than receiving proper treatment in their homes. What is needed instead is person-centred, individualised care and better joined-up service delivery. This requires coordination between health professionals and carers, and the involvement of patients in the decisions on their health, care and support.

Against this background, it comes as no surprise that integrated care is a much-lauded approach when it comes to health care system change. The concept of integrated care seeks to improve patient experience, outcomes of care and effectiveness of health systems through linkage or coordination of services and providers along the continuum of care. By bringing together health care, social care, mental health professionals, independent, voluntary and charitable sectors into the loop, integrated care has the potential to lead to a win-win situation for everyone, resulting both to positive health outcomes and cost-effective services. 

During the last decades different approaches to integrated care have been documented across a variety of care settings, which has resulted in a multiplicity of definitions and conceptual frameworks. The WHO, however, highlights that “any integrated model development is strongly contextually-bound, nearly impossible to replicate and can only be successful if it does account for unique needs and characteristics of the population it aims to serve” (Integrated care models: an overview, 2016). Following this, the question of how to put integrated care into practice still persists. In particular, health authorities face considerable difficulties in contextualising available good practice cases for effectively implementing integrated care within their specific care contexts prevailing in their regions. One of the key reasons for this being that approaches to care integration cannot be reduced to a one-size-fits-all solution. Instead, integrated care needs to be considered as a nested concept, meaning that any approach to care integration has to take into account the different contexts and framework conditions in which care is to be integrated. Contextualisation further requires a common language of all stakeholders involved, that being a shared understanding of what it is they are striving for. This applies also to any adoption of ICT for supporting integrated care services which will only be effective when tailored to the concrete care settings.

Against this background, VIGOUR built a holistic framework based on already existing initiatives, knowledge, guidance and tools which have proven to be successful and in turn helped 15 care authorities to contextualise, plan and implement sustainable care integration models.