Integrated Healthcare

Care pathways
Clinical and Administrative Leads
Feedback routes


1. Cornwell J, et al. Continuity of care for older hospital patients A call for action Kings Fund 17th April 2012

2. Care can’t get better until complaints are listened to BMJ 2012 14 July 34 344

3. Vize, R. A story of hard won success BMJ 9 June 2012 24 344

4. Follow the yellow brick road: integrated care – can we do better? Rickenbach M, Wedderburn C BJGP 2012;62(601):441-442

5. Providing Integrated Care for older people with complex needs Kings Fund report Jan 2014

6. Report of the Mid Staffordshire NHS foundation Trust Public Inquiry (Francis report) 2013

There are many examples of excellent healthcare in the NHS but doctors are often confronted by people who have become lost in the system 1,2,5 . This takes time to sort and leads to frustration, wastes resources and can be of harm to patients 1,2,5. Integration of healthcare can lead to improvements in patient treatment and also lead to cost savings3,4.

Care Pathways

The route taken by a patient through the local healthcare system should be clear and understood for most common conditions. This requires co-ordination, advance planning and focused commissioning. In addition the clinicians should be able to identify and facilitate short cuts in the usual pathwaysof care to tailor treatment for an individual

Clinical and Administrative Leads

Having clear clinical and administrative leads for each bundle of care pathways provides better co-ordination between all the teams involved and allows a patient who is lost in the system to be identifed earlier. Local care pathways that work well allow a healthcare worker to speak to an individual who then resolves the issues. Examples of local enthusiasts who do this job well do exist and include anticoagulation and stroke care

For Integrated care international case studies show that “Personal contact with a named care co-ordinator and/or case manager is more effective than remote monitoring or telephone-based support5″. “Continuity of care and care co-ordination to meet individuals’ specific needs is important and highly valued5″

Feedback routes

An easy route of feedback to an individual lead is required to allow an overview of the problems in the relevant care pathway 2. Currently feedback is disincentivised as it is hard to identify who to tell and rather than being recieved positively it can generate a defensive response. Feedback gives  an overview and identifies where to focus limited resources to maximum effect. Imporved feedback was recommended in the Francis report on poor patient care in Mid staffordshire6

See the talk slides on the  integrated care vision