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Integrated care in mental health: next steps after the NHS Long Term Plan

  • Derek K. Tracy (a1), Kara Hanson (a2), Tom Brown (a3), Adrian J. B. James (a4), Holly Paulsen (a5), Zoé Mulliez (a6) and Sukhwinder S. Shergill (a7)...

Summary

Health and social care face growing and conflicting pressures: mounting complex needs of an ageing population, restricted funding and a workforce recruitment and retention crisis. In response, in the UK the NHS Long Term Plan promises increased investment and an emphasis on better ‘integrated’ care. We describe key aspects of integration that need addressing.

Declaration of interest

D.K.T. and S.S.S. are on the editorial board of the British Journal of Psychiatry and executives of the Academic Faculty at the Royal College of Psychiatrists. A.J.B.J., H.P. and Z.M. have roles at the Royal College of Psychiatrists that include evaluation of integrated care systems. A.J.B.J. is married to Dr Sarah Wollaston, Member of Parliament for Totnes and Chair of the Health Select Committee.

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Copyright

Corresponding author

Correspondence: Derek Tracy, Queen Mary's Hospital, Sidcup DA14 6LT, UK. Email: derek.tracy@nhs.net

References

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1NHS England. NHS Long Term Plan. NHS England, 2019 (https://www.england.nhs.uk/long-term-plan/).
2Institute for Fiscal Studies and The Health Foundation. Securing the Future: Funding Health and Social Care to the 2030s. The Institute for Fiscal Studies, 2018.
3Royal College of Psychiatrists. NHS Priorities and Reform in Developing a Long-term Plan and Multi-year Funding Settlement for England. The Royal College of Psychiatrists’ Proposals for Change. The Royal College of Psychiatrists, 2019.
4NHS England. NHS Five Year Forward View. NHS England, 2014 (https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf).
5Naylor, C, Taggart, H, Charles, A. Mental Health and New Models of Care. Lessons Form the Vanguards. The King's Fund and the Royal College of Psychiatrists, 2017.
6Suter, E, Oelke, ND, da Silva Lima, MAD, Stiphout, M, Janke, R, Witt, RR, et al. Indicators and measurement tools for health systems integration: a knowledge synthesis. Int J Integr Care 2017; 17: 4.

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Integrated care in mental health: next steps after the NHS Long Term Plan

  • Derek K. Tracy (a1), Kara Hanson (a2), Tom Brown (a3), Adrian J. B. James (a4), Holly Paulsen (a5), Zoé Mulliez (a6) and Sukhwinder S. Shergill (a7)...
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eLetters

Integrated Care As An Opportunity for Psychiatry

Benjamin Russell Underwood, Consultant Psychiatrist, RCPsych
17 June 2019

Dear Sir

We read with interest the editorial by Tracy et al. concerning the role of psychiatry in integrated care(1) . Cambridgeshire, UK, is a county with a population of c1 million people. Four years ago a bold attempt was made to commission all healthcare for the elderly, both mental and physical, from a single provider. Following the collapse of that provider, community physical healthcare in Cambridgeshire has been provided by the local mental health trust, creating an integrated Trust (2) . Overnight the trust became responsible for minor injuries units, district and specialist nursing, inpatient physical healthcare, community therapy of all sorts, urgent physical health response and a myriad of specialist teams in addition to inpatient and outpatient psychiatric care for the elderly. This created an integrated workforce of c2,000 delivering over 850,000 contacts per year and a caseload at any one time of 40 to 50,000. As a result, we have some experience to answer the four questions posed in the editorial.

In this case integration meant community physical and mental healthcare for the elderly, and some social care, for the population of the county. There is more to do with our local primary care networks and acute trusts, but crucially the size of ourthe service gives an important seat at those tables where further integration is discussed. The integration of mental and physical health services has bought many advantages for our patients and staff. Some are straightforward, such as consultant geriatricians going in to our older peoples psychiatric wards, but others are less obvious. There has been learning from culture, for example we now have a physical health emergency team modelled on psychiatric crisis teams which has been effective in decreasing the need for physical health hospital admission. The frontline staff have been uniform in their support for the project and though there have been challenges we do not think anybody would go back, hearts and minds have been won. The sickness rates are low and we continue to recruit strongly to shortage posts, for example consultant old age psychiatrists. The service is in financial balance, rated good and in parts outstanding by the CQC and of the 1,100 people who took the friends and family test in April all but 7 said they were likely or very likely to recommend the service..

Though this initiative had a difficult start we feel strongly that integration has been beneficial for patients, staff and the health and social care system more broadly. Integration is not a threat to psychiatry, on the contrary it provides a huge opportunity for us to be on the front foot and lead the next stage of healthcare development in the United Kingdom.

Benjamin R Underwood MA MBBS PhD FRCPsych

Deborah Brown RGN BSc (Hons)

John W Martin DHealth PGC(TLHE) BSc(Hons) FCPara FHEA

1) Tracy, D., Hanson, K., Brown, T., James, A., Paulsen, H., Mulliez, Z., & Shergill, S. (2019). Integrated care in mental health: Next steps after the NHS Long Term Plan. The British Journal of Psychiatry, 214(6), 315-317. doi:10.1192/bjp.2019.462)

2) https://www.nao.org.uk/report/investigation-into-the-collapse-of-the-unitingcare-partnership-contract-in-cambridgeshire-and-peterborough/

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Conflict of interest: None declared

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