The scale and complexity of change in the NHS and care right now has many people baffled. Weighed down with existing responsibilities for keeping the show on the road, new initiatives such as integrated care systems, multi-specialty community providers, and integrated personal commissioning (IPC), can simply add to the sense of confusion, however well-intentioned these are.
If the goal is to still deliver personalised, integrated care, then where does one start?
If we are to succeed in swimming with the tide of all this complexity, and grasp the myriad opportunities inherent in these reforms, then we need to focus in on some of the fundamentals. One of these is having good multi-disciplinary (MDTs) teams.
MDTs: a critical component
Last year we developed an integration logic model which explained what works in bringing about person-centred, coordinated care. Looking at the evidence, and hearing from feedback, it was clear that MDTs are a critical component of integrated care without which you are unlikely to deliver better care outcomes. If you look as well across a whole host of recent evaluations of integration initiatives - including one we did on integrated personal commissioning - you discover that the evidence supports this view. Cordis Bright, writing for us about what all their evaluation work on new models of care (the Vanguards) concluded: 'Multi-disciplinary teams have resulted in a much better experience for patients and users.'
MDTs can be defined as an approach to using the knowledge, skills and best practice from multiple disciplines and across the boundaries that can exist with service providers. To work, MDTs rely on excellent leadership across organisations - sometimes called systems leadership. This sees professionals being willing to compromise and being willing to work differently, using a clear outcome focus, joint training and team development.
Different buildings, same goal
Where MDTs work well their impact can be considerable. In Dudley, as part of the development of a multi-specialty community provider (a form of Vanguard), GP practice-based MDTs involve social care, mental health and voluntary sector workers. They have reduced patient lengths of stays in hospital, increased staff job satisfaction and improved patient and user experiences. In Islington, technology has been harnessed to enable a broad range of professionals, based in different buildings, to connect and decide on how to support patients, leading to reductions in accident and emergency attendances.
It is impressive to see health, social care and housing coming together like this, especially at a time of scarce resources and tensions about how these are allocated. It must now become more commonplace. A commitment nationally to MDTs, which seems to be embodied in most of the reforms, supported by determined leaders locally, should go a long way towards encouraging this expansion.
Ewan King is director of business development and delivery, the Social Care Institute for Excellence
