The forgotten dimension of integrated care: barriers to implementing integrated clinical care in English NHS hospitals

Multimorbid patients who enter English NHS hospitals are frequently subject to care pathways designed to assess, diagnose and treat single medical conditions. Opportunities are thereby lost to offer patients more holistic, person-centred care. Hospital organisations elsewhere are known to use in-hos...

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Published inHealth economics, policy and law Vol. 18; no. 3; pp. 321 - 328
Main Authors Castelli, Michele, Erskine, Jonathan, Hunter, David, Hungin, Amritpal
Format Journal Article
LanguageEnglish
Published England Cambridge University Press 01.07.2023
Subjects
Collaboration
Comorbidity
Delivery of Health Care, Integrated
Family physicians
Finance
Health care policy
Health economics
Health education
Health services
Hospitals
Humans
Information technology
Integrated care
Integrated delivery systems
Medical conditions
Medical referrals
Occupational roles
Patient satisfaction
Patients
Quality of care
State Medicine
United Kingdom > UK
England
United States > US
English NHS hospitals
multi-specialty
integrated clinical care
NHS reform
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Summary:Multimorbid patients who enter English NHS hospitals are frequently subject to care pathways designed to assess, diagnose and treat single medical conditions. Opportunities are thereby lost to offer patients more holistic, person-centred care. Hospital organisations elsewhere are known to use in-hospital, multi-specialty, integrated clinical care (ICC) to overcome this problem. This perspective piece aims to critically discuss barriers to implementing this form of ICC in the English NHS focusing on six key areas: information technologies, the primary-secondary care interface, internal hospital processes, finance, workload, professional roles and behaviours. Integrated care programmes currently underway are largely focused on macro (system) and meso (organisational) levels. A micro (clinical) level ICC, offering highly coordinated multispecialty expertise to multimorbid hospital patients could fill an important gap in the current care pathways.
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ISSN:1744-1331
1744-134X
DOI:10.1017/S1744133122000214