Integrated care
Integrated care has been a key issue for The King’s Fund for many years, but not many will know this ambition goes back through much of our time as an organisation. In 1903 the Fund started to encourage voluntary hospitals to consider where they should be best placed to meet the needs of local populations: ‘it is to be hoped that in time some more methodical distribution of these institutions [hospitals] may be brought about.’
In the 1950s the Fund was not only involved with hospitals but also convalescent and recovery homes for people after they were discharged from hospital, providing accommodation, care and nursing to aid recovery. Recognising a need for care outside of hospitals, the Fund pledged to open 12 recovery homes intended for the rehabilitation of chronically ill elderly patients. In 1954, as it opened its 10th recovery home, The King’s Fund published a report, Recovery homes: a report of an inquiry into the working of recovery homes and their value to the hospital service, which detailed its investigation into recovery homes. The inquiry was initiated at a time when hospital authorities were beginning to think that the addition of recovery homes might help to provide a better hospital service.
Working together : a study of co-ordination and co-operation between general practitioner, public health and hospital services (1968)
Working together : a study of co-ordination and co-operation between general practitioner, public health and hospital services (1968)
It was in the 1960s when the Fund took on a role of influencing and informing NHS policy at a time of great change across the national health system. The Fund started to highlight the potential for integrating services across health and social care (or social services, as it was known then). In 1968, the Fund published a report sharing local examples of best practice in co-ordination and co-operation across health services, with the aim of informing the discussion around government’s Green Paper on the administrative structure of medical and related services in England and Wales. A major theme of this Green Paper was how to improve the relationship between the NHS, social care and related services – a theme that still resonates today. In this report the Chair at the time, F Avery Jones, said ‘The task of complete integration at the beginning [of the NHS] would have been too great; but for main this remains an ultimate objective’. This briefing went on to say ‘concentrated efforts throughout the country to increase […] the unification of services’ to ‘improve the service to the patient’.
With a growing interest in integration, in 1971 the Fund designed a series of experimental courses aimed at medical professionals and senior managers. It focused on how to manage integrated services and conduct an operational study of how services might be integrated at the area level. At that time integration of health services was seen as the biggest organisational change since the start of the NHS, ‘the Fund, in common with other training centres, was asked by the Department of Health and Social Security to design a series of experimental courses for senior officers of all disciplines to stimulate study of the needs of management within the context of an integrated service.’
In the lead up to National Health Service Reorganisation Act in 1973, the Fund published further reports emphasising the importance of integrating health and care services. The shape of hospital management in 1980? argued that the ‘National Health Service as provided by hospitals, local authorities and family practitioners must draw closer together as time goes on and become more integrated with welfare services’.
‘the Fund, in common with other training centres, was asked by the Department of Health and Social Security to design a series of experimental courses for senior officers of all disciplines to stimulate study of the needs of management within the context of an integrated service.’
Health and welfare of the elderly (1979)
Health and welfare of the elderly (1979)
In the lead up to National Health Service Reorganisation Act in 1973, the Fund published further reports emphasising the importance of integrating health and care services. The shape of hospital management in 1980? argued that the ‘National Health Service as provided by hospitals, local authorities and family practitioners must draw closer together as time goes on and become more integrated with welfare services’.
The Fund also undertook a number of projects looking at the health provision of specific groups. Health and welfare of the elderly, published in 1979, provided a review of services in order to make recommendations ‘towards an integrated health care system for the elderly’. Looking at provision of health and care through the lens of an increasing older population lens has been a thread through our work at local, national and international levels. Towards an analysis of the health and social care needs of older Londoners, published in 1997 is one example of this.
In more recent times, The King’s Fund has way of highlighted examples of best practice internationally, through its 2014 publication Integrated care for older people with complex needs: lessons from seven international case studies, which shared case studies from other countries, such as New Zealand, Canada and Sweden.
The King’s Fund has also advocated for system change throughout many of its reports and even commissioned a review of potential ways to fund social care, in what became known as the Barker Commission, as well as considering the types of roles needed to work across an integrated system.
These recommendations have run alongside a number of initiatives by the government to implement plans towards integrated health and care, such as Lord Darzi’s NHS Next Stage Review introducing a new concept, of an integrated care organisation. In April 2014, we wrote a report about the new sustainability and transformation plans , which were seen at the time as the key ‘plans for the future of health and care in England,’where local health and care services were asked to collaborate in responds ‘to the challenges facing local services, This marks a decisive shift from the focus on competition as a means of improving health service performance in the Health and Social Care Act 2012.’
The Fund has always played a role in explaining complex systems through publishing case studies and explainers as well as reports like Integrated care: What is it? Does it work? What does it mean for the NHS? in 2011. Now with the introduction of integrated care systems from July 2022 the Fund continues to play a role in influencing, supporting and integrated services. Our role is often to explain how complex system changes may work in practice and we have found more creative ways to illustrate these concepts.
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