By Helen Murdoch, Chief executive, Hanover Scotland housing association
ALL across the world, people talk about the benefits of “integrated care”. The reasons are manifest, ageing population, reduced budgets or complex conditions but integrated care is a “good thing”. But what is it? Who is it for? How will it improve quality of life? And how will anyone know if a person is better off?
These were the questions I was faced with last week at the International Conference on Integrated Care in San Sebastian, Spain, with Hanover Scotland the only Scottish housing association invited to attend.
As well as presenting our paper on new research putting older residents at the heart of shaping future housing and services, I was inspired to be with 1,300 representatives from across the world. What was most remarkable was that everyone shared the same set of problems and the passion to overcome them.
I was particularly struck by the realisation amongst attendees that housing needs to be part of integrated care, alongside health and social care. But I was also frustrated that this hasn’t been done and that the only examples were small and localised – exactly the same as in Scotland.
It got me thinking about why this is the case. First, I think, is complexity. It was clear during the conference that no one size fits all and integrated care is a complex puzzle, which it is felt housing adds to. This causes a lack of clarity and institutional silos, leading to muddling through with good intent. The complexity can’t be resolved but must be managed better.
Second, we need to think more clearly about the problem we are trying to solve and the outcomes we are trying to achieve for people. We are good at designing pathways addressing current problems but not at using data to begin solving tomorrow’s problems. Doing so would allow us to look at what is needed in integrated care in the coming years and it should highlight how to include housing in that picture.
Finally, we need to find a way to resolve the issue of culture in integrated care. As one delegate at the conference described it, “culture goes as deep as the origin of the service”. So, in the creation of a new integrated service, cultural change cannot be achieved using existing models of delivery. Unless mindsets can switch to new models of care and collaboration, we could be building a culture that makes integrated care harder to deliver. This is where integrated care needs to keep it simple, involve all key players, and slowly build a new culture with the outcomes we are seeking for people in need at its heart.
The example from the conference which best showed this approach came from a charity called CHATS from Ontario, Canada. Their “Home at last” project was incredible and one I would like to see tried in Scotland because it links health and social care with housing at a granular level. This isn’t just a care package; it is an A-Z of what a person requires before they leave hospital, down to making sure the electricity is working, there is food in the fridge and meals in the freezer.
Countries seem to be at the same place on integrated care, giving Scotland the opportunity to become an international leader. When shaping its thinking for the future, this should begin with the fundamental questions I started with: “Who will be better off?”, “How will they be better off?” and “How will we know they are better off?”
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules here