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Nurses can help sell benefits of integrated care to public, say MPs

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Nurses could play a valuable role in advocating for better integrated care after government failures in getting the message across, according to an influential committee of MPs.

The Commons health and social care committee said ministers and NHS leaders had struggled to communicate clearly why reforms enabling more integrated care were necessary.

“Any effort to transform care will founder and lose support unless it can demonstrate that patients will benefit”

Sarah Wollaston

In a new report, the committee said that, as people were now living longer with increasingly complex health and care needs, there was an urgent need for better joined up working between the NHS and social care.

But the government had yet to make a persuasive case for more integrated care and the message had become mixed up with public fears over budget cuts, said the report said – titled Integrated care: organisations, partnerships and systems.

With public trust in nurses standing at 93% and doctors at 91% – far higher than the 17% trust in politicians – the report authors suggested NHS staff could help persuade the public.

“NHS and social care professionals are likely to be the best advocates for more integrated care,” the report stated. “Effectively communicating service change to the public depends on who presents the message as well as the message itself.”

“NHS and social care professionals are likely to be the best advocates for more integrated care”

Committee report

However, any new communication strategy must avoid “acronym spaghetti” and use simple language that staff and patients can easily understand, the MPs warned.

“National and local leaders need to do better in making the case for change and how these new reforms are relevant to those who rely on services. The language of integrated care is like acronym soup: full of jargon, unintelligible acronyms and poorly explained,” noted the report.

The opaque language has created mistrust, the report highlighted. “[It] has fuelled a climate of suspicion about the underlying purpose of the proposals and missed opportunities to build goodwill for the co-design of local systems that work more effectively in the best interests of those who depend on services,” it stated.

The report noted the example of sustainability and transformation partnerships, which were set up in 2016 by NHS England to boost integration of services. There are 44 STPs covering the country, where NHS organisations and local councils are developing shared proposals to improve health and care.

“Much of the debate around accountable care organisations has been confused and misleading”

Saffron Cordery

But the report noted that, in his evidence to the committee, NHS Confederation chief executive Niall Dickson had questioned whether the public were aware of the initiative.

“I suspect that Mr and Mrs Smith walking down the road probably do not know what STP stands for and do not understand a lot of this process,” he said. “That is part of the problem, but the way it was launched and people’s genuine fears about what might happen have become attached to both the letters and the process, and we have to move on from that.” 

The report called for communication to be tested on a representative sample of the public. “A clear patient-centred explanation, including more accessible, jargon-free, language, is an essential resource for local health and social care bodies in making the case for change to their patients and wider communities,” it stated.

The report noted that there were many examples of NHS and care services integrating services effectively.

It highlighted Frimley Health, where patients in need of urgent medical care were seen by members of an interdisciplinary team consisting of GPs, nurse practitioners, paramedics and other relevant healthcare professionals.

Dorset was also planning to introduce community hubs in which GPs, specialist doctors, nurses, physiotherapists and social care workers work in one place to provide quick, effective support for rural parts of the county, said the committee.

“Safe and effective staffing is vital if we are to achieve this for people in England, and ministers should take note”

Lara Carmona

It also noted expanding bodies such as Accountable Care Organisations (ACOs) – a single group that holds a 10-15 year contract for the health and care of a large population – offered the chance to increase integration and roll back the NHS internal market.

But further integration was hampered by current legislation, the MPs said. They called on the government to bring forward legislation to remove legal barriers imposed by the Health and Social Care Act 2012.

In their report, they said: “If a decision is taken, following a careful evaluation of pilots, to extend the use of ACOs in the English NHS then the committee recommends that these should be introduced in primary legislation as NHS bodies.”

Committee chair Dr Sarah Wollaston, Conservative MP for Totnes, said better communication was urgently needed.

Sarah Wollaston

Hunt hints that pay rise will be linked to staff contract changes

Sarah Wollaston

“As MPs, we too often see our constituents, their families and carers grapple with local services that may be poorly organised around their needs and struggling to cope with the rising demand for care,” she said.

With the NHS approaching its 70th birthday, she called for leaders from across politics to make the case for change to the public.

“Any effort to transform care will founder and lose support unless it can demonstrate that patients and their families will benefit,” said Dr Wollaston.

Lara Carmona, associate director of policy and public affairs at the Royal College of Nursing, praised the report’s conclusions.

“Integrated health and social care services are key in helping patients with increasingly complex health needs,” she said. “This report acknowledges that safe and effective staffing is vital if we are to achieve this for people in England, and ministers should take note.”

She said that keeping people out of hospital using walk-in centres or treating them at home, should be a priority. But without a credible workforce strategy it was “a stretch” to demand services be transformed, warned Ms Carmona.

“The rise in emergency admissions shows just how overstretched our community services are – there has been a 15% drop in the number of full-time equivalent nurses working in community services in England between May 2010 and July 2017,” she said. “Effective integration will remain a fantasy until the government gets to grips with recruiting and retaining more nurses.”

Saffron Cordery

Saffron Cordery

Saffron Cordery

The report was also welcomed by Saffron Cordery, chief executive of NHS Providers. “It highlights the growing tendency to pin performance and financial obligations on STPs, even though they lack the mandate, the means and the legal authority to deliver them,” she said.

The MPs had set out the “conditions and characteristics” needed for closer integration and how some areas have progressed more quickly than others, she said, agreeing with their call for greater clarity.

“Much of the debate around accountable care organisations has been confused and misleading,” she said. “We need a clearer strategy to support the move to integrated care.”

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