A summary of what delivering better integrated care means and how Monitor is supporting the sector.

What does delivering integrated care mean?

People benefit from care that is person-centred and co-ordinated within healthcare settings, across mental and physical health and across health and social care. For care to be integrated, organisations and care professionals need to bring together all of the different elements of care that a person needs.

A person’s care may be provided by several different health and social care professionals, across different providers. As a result people can experience health and social care services that are fragmented, difficult to access and not based around their (or their carers’) needs. However, good integrated care can reduce:

  • confusion
  • repetition
  • delay
  • duplication and gaps in service delivery
  • people getting lost in the system

Delivering integrated care is essential to improving outcomes for people who use health and social care services. Reducing gaps and inefficiencies in care should also be able to offer some opportunities for financial savings.

The definition of integrated care and support

National Voices’ ‘A narrative for person-centred, co-ordinated care’ provides a definition of what good integrated care and support looks and feels like for people. We ask local areas to sign up to using it as well.

This narrative sets out what person-centred, co-ordinated care should mean in practice and is a guide to the sort of things that integrated care will achieve, including:

  • better planning
  • more personal involvement of the person using services
  • free access to good information

This is written not just for the experts, but for patients, people, families and carers. It also provides some clarity over what local areas should be aiming to achieve in their efforts to integrate services. Healthcare providers and commissioners have opportunities to promote the interests of patients by ensuring that health and care services are co-ordinated and meet their needs.

How is Monitor supporting the sector to deliver better integrated care?

Across all areas of our work we have a duty to enable care to be delivered in a more integrated way, both in healthcare and between health and social care, where this is in a person’s interest.

We strongly believe that providers and commissioners should lead in developing integrated care approaches for their local populations. Where attempts at integration are unreasonably blocked, Monitor may step in to address such detrimental action.

Along with our national partners, we aim to help ensure better outcomes for people by creating the conditions for person-centred, co-ordinated care to thrive locally.

We have powers to enable integrated care which help us to:

  • provide flexibility so that new models of care can emerge
  • support local areas in their plans for integrated care
  • ensure that the sector does not stand in the way of efforts to deliver care in an integrated way

Read this report on factors that can enable or block integrated care (PDF, 1.6MB, 87 pages) .

Watch this webinar on aligning strategies across local care economies.

Providing flexibility for new care models to emerge

We encourage innovation and want local areas to design an approach that best meets the needs of people. We are developing a payment system that rewards high quality, efficient providers, and incentivises co-ordinated care. The national tariff also allows for innovative payment approaches such as capitation (setting an annual whole person care budget that is aligned with clinical and financial accountability) and pathway payments.

We are working to ensure our NHS foundation trust assessment process can accommodate new organisational forms, such as integrated care organisations.

We are working with providers and local health economies to find out if integrated care can be part of the solution to help sustain essential services, as well as with those looking to change models of care delivery to improve patient care and efficiency.

Working with national partners

We work with national partners to promote, enable and encourage integrated care and support. Together we co-wrote ‘Integrated care and support: our shared commitment’, setting out a clear direction on integrated care. It explains what good person-centred, co-ordinated care looks and feels like, and how we will work together to achieve it over the coming years.

Five Year Forward View vanguards

The Five Year Forward View, published in October 2014, highlights the importance of integrated care. It describes a number of models of care that can play a role in integrating services across different care settings, including multispecialty community providers and primary and acute care systems, which both focus on care pathways across primary, community and acute providers. Vanguard sites have been selected to lead on the development of new care models and you can read more about this on the NHS England website.

Integrated care pioneers

25 integrated care pioneers are looking to make progress at pace so that we can gather more evidence of what works well and we are supporting them with this work.

The pioneers demonstrate ambitious and innovative approaches to efficiently delivering person-centred and co-ordinated care across their local health and care system for the benefit of people. They are at the forefront of sharing and promoting what they’ve learned for wider adoption, dissemination, promotion and uptake across England.

The pioneers were launched in December 2013, with 14 local areas selected to act as exemplars. In January 2015, these 14 pioneers produced an annual report detailing the achievements, challenges and learning from their first year. It includes individual profiles of each pioneer, as well as case studies and examples from across the programme.

In January 2015 the integrated care pioneers programme was expanded to 11 more areas.

A report published in January 2015 outlines the support that has been provided by Monitor, and other national partners, to the integrated care pioneers.

Find out more about each of the pioneers’ ambitious and innovative approaches (PDF, 686KB, 31 pages) to efficiently deliver integrated care.

The integrated care pioneers are part of a wider programme of work to support the delivery of integrated care at pace and scale. Monitor and its partners are supporting all local areas in meeting the aims of the Better Care Fund.

Procurement, patient choice and competition

Competition and integration are not mutually exclusive and competition does not, and should not, have to come at the expense of beneficial co-ordination.

In the area of choice and competition, we can act to prevent commissioners or providers behaving in an anti-competitive way against patients’ interests. Integrated services that seek to provide the best care for patients - for example, by sharing patient information to improve handovers - will likely raise few competition concerns. If tensions do emerge, we will consider patient interests and seek to suggest remedies.

Integrated care licence condition guidance

Our role in enabling integrated care is supported by the NHS provider licence, which has an integrated care licence condition. We have published guidance to help licensees and NHS trusts understand what is expected of them in relation to the integrated care licence condition.

We encourage healthcare providers, commissioners and other interested parties to get in touch if they have any queries or concerns about the integrated care licence condition and how it is likely to apply in particular circumstances.

Help, advice and contact

For questions about Monitor’s role in enabling and supporting integrated care, please email enquiries@monitor.gov.uk.

You can contact Monitor to raise your concerns if you think that a licensed healthcare provider may have breached or is going to breach the integrated care condition of the NHS provider licence.

For specific questions on procurement, choice and competition issues, please email: cooperationandcompetition@monitor.gov.uk.