Everyone agrees that coordinating care around the patient is important – so why does it keep on not happening? 3

Put people who have shown they can create integrated services in charge of the system

To recap for new readers.

For the next few weeks I am laying out how I think any new contract between the NHS and the British people will need a set of delivery mechanisms if it is going to create new outputs. I will not be talking about what we should be aiming for but how it will need to be delivered. This week we are looking at how it will be necessary – despite NHSE setting up 14 fragmented working groups to work on the future – to deliver the new outcomes through person-centred coordinated care – or what in policy terms is called “integration”.

Over the last 10 to 12 years, whilst there has been a policy of integration, there are hundreds of local leaders who have grabbed the opportunities to integrate aspects of care and have the experience of how this can be achieved. A few have achieved this at a local system level; most have achieved it between two or three organisations. They have succeeded in this process by working with one of the very many pilots, pioneers or vanguards that the DH and latterly NHSE have promoted over this period. Millions of person days of change have been poured into leading these different schemes and it seems to me – if the national system of NHS and social care really want to develop full integration, it will learn from this concrete experience of creating new forms of care.

Healthcare systems all over the world are struggling to integrate, so the leadership experience of actually doing this – however small the services that have been integrated – should be seen as a crucial national resource. A wise NHS and social care system would therefore want to know in detail who those leaders are and how their talent can be used to teach others the detail of creating of person-centred coordinated care.

If the system genuinely wants to integrate the first action that it should undertake should be to log and understand where these skills reside. Who has done what where? On a regional basis it would be really useful to know who has successfully integrated GP, community health and social care services. Just a bit on what they achieved and what they are doing now.

I think we would find a lot of local, detailed leadership and a bit on a wider system basis. It really is no good talking about leading integration in a generic way. What leaders who want to coordinate their services need to know is how, in detail, to achieve that. Tool kits don’t do this – human interaction does.

Two things then need to happen.

Firstly these people – those with concrete experience of how to lead integration – need to be given some development training on how to get that experience across to other people. Given these hundreds of people need to get their experience across to tens of thousands of other leaders, we need them to be in a position to ‘teach’ that experience. Empowering the people who have already achieved something to teach the thousands of people who have not had the opportunity but want it – seems a wise use of public service resources.

Secondly, there is a simple idea that if you really want to create an integrated system of care, you should put leaders in charge of the system who have demonstrated that through their leadership they can create it. You will then have people in charge of the system who understand how to transform the present fragmented services into a much more coordinated system.

Having written this it all seems a bit obvious. But it is really radical. If we want a hospital centred health care system then continue to put people in charge of it who have run hospitals.

But if we want an integrated care system to develop then we must put people in charge of it who have already integrated care at some level.

Or should we simply admit defeat, forget about integration and carry on fragmenting the service?