These new models of care can be used across the UK and have been a particular positive for many, with the opportunities they offer for more care at home, integration of services and increased collaboration all being cited. Connecting the system will also empower children and their families to access timely advice for the management of their conditions.
Links are to RCPCH web pages unless otherwise noted
Commissioning and planning arrangements of NHS services can result in pathways of care becoming fragmented and disorganised, with a lack of clarity over who should be responsible for providing which service. Such disputes can lead to poor communication with children and their families and ultimately poor patient experience and inconsistency in how children should be managing their conditions.
In 2016, NHS organisations and local councils in England came together to form sustainability and transformation partnerships (STPs) in 44 areas as a means for NHS organisations, local authorities, and clinical commissioning groups to work together to improve health and wellbeing of a population in a particular area . All STPs are now expected to have developed into an integrated care system (ICS) by April 2021.
General resources for England
- Integrated care explained
- ICS and STP strategic plans - recommendations
- Resources and case examples of integrated care models around the UK - on RCPCH QI Central
RCPCH Ambassadors programme
Ambassadors advocate locally for the integration and improvement of local services in ways that benefit children and young people, and the workforce that serves them.
- Case for investing in integrated child health services for the acutely unwell child and long term conditions
Facing the Future sets out a vision of how paediatric care can be delivered to provide a safe and sustainable, high-quality service that meets the health needs of every child and young person.
- Facing the Future - standards for children and young people in emergency care settings
- Facing the Future - standards for ongoing health needs
- Facing the Future - together for child health (apply to unscheduled care pathway)
- Bringing networks to life - a guide and resources to implement clinical networks
- NHS Long Term Plan - Mental health - RCPCH submission to NHSE, 2018
- Role of paediatricians in supporting children and young people's mental health - position statement
- Blog from Dr Karen Street, RCPCH Officer for mental health, March 2020 - Karen introduces our chapter on mental health in the College's State of Child Health report, reissued in March 2020, by exploring the challenges faced by young people today, and the lack of prevalence data in this country.
- NHS Confederation - integrated care systems in workforce development, England - May 2019
- Contracting arrangements for Integrated Care Providers - October 2018
- Future of general practice - consultation response to RCGP - 2018
Since 2016, work has been underway across Scotland to integrate health and social care services in line with the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014. It is a strategic priority for Scottish Government to ensure the integration of the planning and provision of care, partners in the public, third and independent sectors are improving people’s experience of care along with its quality and sustainability.
There are 31 integration authorities who are responsible for funding for local services. These authorities are required to work with their local communities and providers of care to ensure care is responsive to people’s needs.
Resources in Scotland
The Health and Social Care Delivery Plan (December 2016) - This plan sets out the current trajectory for integrating care.
Health and Social Care integration: progress review - This report reviews the progress and draws together the proposals for ensuring the success of integration (against the set principles and outcomes).
Children's services planning: guidance - This provides local authorities and health boards, working in partnership with other public bodies and organisations, information and advice about how they should exercise the functions conferred by Part 3 (Children’s Services Planning) of the Children and Young People (Scotland) Act 2014. Part 3 of the act seeks to improve outcomes for all children and young people in Scotland by ensuring that local planning and delivery of services is integrated, focused on securing quality and value through preventative approaches, and dedicated to safeguarding, supporting and promoting child wellbeing.
Integration of health and social care has been a stated objective for government and the NHS since the Welsh Government published it’s long term plan for health and social care, which is called A Healthier Wales. The plan states that:
In each part of Wales the health and social care system will work together so that people using them won’t notice when they are provided by different organisations. New ways of joined-up working will start locally and scale up to the whole of Wales. We will make sure local services learn from each other and share what they do, because we want everyone in Wales to have the same high quality services.
This is on page 3 of the plan (PDF).
There are a number of frameworks, policies and pieces of legislation that attempt to take this forward.
Pre-dating the strategy, A Healthier Wales, the Social Services and Wellbeing Act (2014) placed an emphasis on collaboration and partnership working to improve outcomes for people who need care and support. One of the key vehicles for achieving this is the establishment of Regional Partnership Boards (RPBs). Established as part of the Act, these bodies bring together Health, Social Care and the Third Sector in each RPB area.
The Additional Learning Needs and Education Tribunal (Wales) Act provides a single legislative system relating to the support given to children and young people who have additional learning needs (ALN) and are receiving education and/or training. It means that children and young people with ALN should receive an Individual Development Plan (IDP) with input from relevant health, education and local authority services.
Resources in Wales
- A Healthier Wales
- Regional Partnership Boards
- ALN factsheet for children, young people and their parents or carers
- ALN factsheet for health services
Integrated health and social care dates back to 1973 and the NHS is known here as the Health and Social Care System. The system was reformed in 2009 by way of the Health and Social Care ( Reform) Act (PDF) in order to improve integration through the reorganisation of health and social care services This Act established a central Health and Social Care Board, five Health and Social Care Trusts, the Public Health Agency and five local commissioning groups.
Resources in NI
Health and Social Care Board (HSCB) - This is responsible for commissioning services, resource management and performance management and service improvement. It works to identify and meet the needs of the Northern Ireland population and works with the Public Health Agency and the Local Commissioning Groups to commission services which manifest in an annual Commissioning Plan. The Board also manages contracts provided by GPs, dentists, opticians and community pharmacists not provided by HSC Trusts.
Public Health Agency (PHA) - The PHA has the key functions of improving health and wellbeing and health protection. It also provides professional input to the commissioning process. It is jointly responsible (with the HSCB) for the development of a fully integrated commissioning plan for health and social care in Northern Ireland. The PHA works in partnership with local government, key organisations and other sectors to improve health and wellbeing and reduce health inequalities.
In recent years there has been a programme of work to strengthen Primary Care services though developing GP Federations established to protect GP practices and to help deliver the transformation agenda in Northern Ireland. Primary Care has also been expanded though Multi-disciplinary teams.
Health and Social Care (HSC) Trusts - There are six HSC Trusts that provide integrated health and social care services across Northern Ireland. These manage and administer hospitals, health centres, residential homes, day centres and other health and social care facilities and they provide a wide range of health and social care services to the community.
Strategic drivers in NI
A series of strategic reports have driven the programme for change in the past decade: