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Joining up care for patients: how can we make it easier?

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Dr John Dean, medical director (transformation) at East Lancashire Hospitals NHS Trust and the clinical lead for the Trust’s Future Hospital development site project, explains why joined up, integrated care is the only way forward for hospitals.

I have been an advocate for integrated care for much of my professional life; you would expect that from a clinician working in diabetes and acute medicine. People mean different things by integrated care, but to me it’s about looking at all of the patient’s needs and being part of the team that works with them to address these. We are privileged as physicians to meet patients at some of the most vulnerable times in their lives, and to work with a number of great professionals who all bring important and different perspectives to the care and support of individual or family needs. Medicine can be at its most rewarding when we work well as part of a team. So why is it so difficult to deliver care in a joined up fashion for patients, wherever they are – in hospital, at home, in a clinic or moving between them?

‘Us’ vs ‘them’?

The barriers we have to this are organisational and professional, but are largely cultural. These are exaggerated by the way we operationalise care and by perverse incentives. So if for much of your professional life the messages have been about ‘us’ and ’them’ – hospital vs community, specialist vs GPs, clinician vs social worker or commissioner vs provider – without adequately sharing information, problems and challenges, and solutions and benefits, then it will take time to change.

The Future Hospital Commission report sees a different future of joined up, coordinated and high quality care, with specialists and generalists working as teams in all settings, and putting patients’ needs before the organisational or professional need. It’s a future that we want to move to as quickly as possible, and understand and overcome the challenges. That’s why our team at East Lancashire Hospitals became a Future Hospitals development site.

The Future Hospital Commission report sees a different future of joined up, coordinated and high quality care, with specialists and generalists working as teams in all settings, and putting patients’ needs before the organisational or professional need.

Dr John Dean

Although it is challenge, we continue to make progress. Some of the things that help to drive this work forward include:

  • the clinical leadership consistently sharing responsibility for the whole care a patient needs
  • seeing each other’s worlds
  • sharing each other’s challenges and planning the solutions together across organisational or professional boundaries
  • sharing clinical information
  • celebrating what is possible when we work well together.

To do this we need to build trust and respect different perspectives. We also need to be very resilient; we will keep stumbling along the way, but we know it’s the only way to go.