Integrated care: a cross-European perspective

NHS Confederation, integrated care
Elisabetta Zanon, Director - NHS European Office

Confronted with the challenge of the increasing burden of chronic conditions, a number of healthcare systems and organisations across Europe have developed strategies and put in place a range of initiatives aimed at promoting integrated person-centred care for chronic condition patients, while at the same time looking at how to make their systems more financially sustainable.

These measures have led to significant changes in the way care is organised and delivered locally. In some cases, this has meant a move away from a system where organisations typically offer a single service provision such as acute, mental health or community care, to one in which multidisciplinary organisations offer a range of increasingly integrated services. In other cases, organisational boundaries have been overcome by different bodies in the health and care system working in a more collaborative fashion to deliver better care for the local population.

European success stories

Successful European models of integration include Jönköping in Sweden, Gensundes Kinzigtal in Germany, Alzira in Spain and Buurtzorg in The Netherlands. The NHS European Office has studied these in depth – along with other successful European models of integration – and identified possible lessons to share with NHS leaders. An overview of these EU models and the European Office’s work to showcase them to the vanguard and integration pioneer community is available here.

While these models are different, their success relies on some common principles, including:

  • Rethinking clinical models beyond existing organisational boundaries.
  • Leadership and cultural change across professional groups.
  • Collaborative multidisciplinary working across the health and social care workforce.
  • Sharing of patient information and data across providers.

The ability of sharing patient data quickly and easily between providers and professionals in the system has been highlighted as a particularly critical factor of success. It has required investment in innovative information and communication technologies, allowing health and social care professionals to be able to access and share patient information when providing care to the individual.

Ensuring continuity-of-care

For example, technology allows GPs in Alzira to get clinical advice from specialised physicians on some symptoms, without the need to refer the patient for an actual visit to the hospital. Sharing patient information in a timely fashion is also of crucial importance when the patient is discharged from hospital, to ensure continuity of care by other providers and reduce the risk of readmission. 

Innovative technology has also enabled data to be used in support of preventative measures targeting groups of the population at higher risk of ill health, thanks to the use of sets of indicators. For example, in the Gesundes Kinzigtal model, the use of patient data for risk stratification measures for diabetes, linked to prevention initiatives and personalised care plans for groups at higher risk, have led to a significant reduction in hospital admissions for this population group.

Barriers to integration

But the technology in itself is not all. It is also essential to ensure that the regulatory framework provides clarity on how and when data can be shared between health and social care professionals, as confusion and uncertainty has sometimes existed in this area, creating barriers to the provision of truly integrated care. 

The new EU regulation on data protection, which was recently agreed after a long process of negotiations at EU level, is a welcome step in this direction. The new EU rules will allow data to be handled more effectively, breaking down information barriers, and allowing care to be delivered in a more effective and integrated manner, while simultaneously maintaining confidentiality of personal data. More specifically, it will bring clarity that carers outside a regulated profession will also be able to access patient data if they have a legitimate reason to do so. So while the common law duty of confidentiality remains, national rules or law could make it easier and clearer for the health service to share data with organisations in the social care and voluntary sectors for the provision of more joined-up care to patients.