>> Don: Integrating care matters because our lives properly conducted are integrated. We're
not our diseases we're not a broken arm or diabetes we're whole people who are making
journeys through our lives and the care system has to honour and respect that. It also is
a way to produce much better outcomes if you can help me through time and space instead
of just in episodes. That's even more true now in an era when chronic illness is so much
with us. I think the National Health Service probably
has a better chance to truly integrate care than almost any other health care system in
the world. You're integrated at the top funded from general taxation with a chartering duty
to the public to give service free at the point of care. It gives you an opportunity
to be a team right down to the sharp end where people get care. That hasn't always been the
case in the NHS care gets fragmented at the local community level. What I see now in the
move towards integrated care systems is a chance to change that. So teams and teamwork
characterise care right down to the point of contact with individual patients and families.
You've got a treasure of changes here with individual places that have really experimented
with new ways to deal with partnerships between general practice and specialists new ways
to help patients flow back to their communities and get out of institutions new ways to use
modern information systems to help people new ways to build teams. All of that is now
available and as you build the integrated care systems if you're wise enough and you
are to tap these lessons that are distributed all over the country you can put together
models that are really based on experience. Also the new care models programme has generated
a sort of faculty of clinicians, managers, nurses, doctors who have actually seen the
changes they know how they work and they can become teachers to the country.
I don't think that you can be successful with the integrated care idea without elevating
cooperation to the number one position in terms of professional duties norms the way
we act together. That means we have to build relationships across boundaries that have
been rather carefully tended. Now to build relationships takes time and right now the
national health service is under enormous pressure budget pressures productivity pressures
demographic pressures. You're going to have to find the time. Without investing in relationship
building getting to know each other and understanding how to work together success will be more
elusive. I see that as the biggest barrier. I hope you invest in the building of cooperative
relationships as an absolutely essential resource for building integrated care.
The organisation that I led and am now senior fellow in the Institute for Healthcare Improvement
has articulated the triple aim better care better health and lower cost all at the same
time. To that we sometimes add a fourth aim which is joy at work the quadruple aim. That
should be the aspiration. There's no reason the national health service in England can't
have the best care in the world. There's no reason why you can't take an appropriate proportion
of your efforts and move them upstream to the causes of illness and use social determinants
to prevent illness and there's no reason why you have to waste money. You have limited
resources and you can use those resources increasingly wisely. And in that system that's
focused on health and wellbeing and efficiency in the sense of getting the job done you can
have a workforce that's prouder and more joyous in what it does. I know how unrealistic that
may sound at a time of stress but this move towards integrated care systems that hold
the potential of the triple aim plus joy in work nothing less.