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  • Writer's pictureJohn Copps

The NHS’s vision of integrated care is about catching up with what the public already thinks

Patients think of the NHS as one coherent service. Managers and clinicians making the transition to integrated care can draw strength and encouragement from that, says John Copps.

The NHS is a peculiar beast. Everyone in the UK has a stake in it, but very few understand much about how it works.


It is a service – or group of services – that looks after us when we are born, where we go when we are sick or injured, and that cares for us in our old age. It lives in our minds as a place of safety and reassurance, even in the times we don’t use it.


But few – very few – people know much about how it works. Let’s face it, thinking about NHS strategy is a niche interest. It is a specialist subject worthy of Mastermind.


One key feature of this high-stake/low knowledge duality is the public’s tendency to think of the NHS as one entity: ‘our NHS’. Rarely do patients see a distinction between the different organisations within the NHS that care for them. In most of their mind’s eye, their GP is part of the same service as the district nurse that dresses their wounds or the registrar that visits them in their A&E bed.


Only nerds or those close to the detail know that GPs are independent self-owned partnerships, the district nurse is employed by whoever won that contract in that area, and the registrar is part of a hospital trust.


By common understanding the NHS is currently in crisis, hit by workforce shortages, record waiting lists, a winter flu/COVID pandemic, a crumbling estate, and acute issues in both General Practice and emergency care. The origins of this crisis can be debated, but it is widely accepted that reform is part of the solution.


The biggest structural change offered to address this is a move to integrated working – for the constituent parts of the NHS to work together as a joined-up service. Integrated Care Systems, ICBs, provider collaboratives and the dissolving boundary between providers and commissioners, are all an expression of this direction of travel.


Making these changes are hard and sometimes painful. It requires a new way of thinking, challenging deep-held assumptions and letting go of vested interests. As we have already seen across the country, NHS providers are being compelled to buddy up with partners that they have spent decades competing with.


For managers and clinicians adjusting to and preparing for change, it is helpful to be reminded of where patients stand. With their view of ‘one NHS’, integrated care is something that many assume was happening already, even if it isn’t always done well. From that, it is not a stretch to suggest that patients would be more than happy to see NHS organisations working together to agree one set of goals and priorities to keep their local population healthy.


As organisations make the transition to more joined-up working, those at the sharp end of the changes can draw strength and encouragement from this. Everyone working in the NHS knows that listening to their patients is critical. The transition to integrated care is another reminder that this statement is a truism.


To read more on Mutual Ventures' work on integrated care and provider collaboration click here.

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