How healthcare providers and commissioners can respond to the need for coordinated care
by Cheryl Gowar
Last Friday, NAT launched a new policy briefing Providing coordinated care for people living with HIV. In my first blog I discussed some of the issues around integration and coordination of care for people living with HIV who are also living with other long-term conditions. Here, I consider what those who provide and commission healthcare need to be thinking about to make sure that care responds to those integration and coordination related needs.
Ironically, the HIV care of yesteryear developed in a way that involved precisely the sort of integration and coordination that we now need to reinvent to suit new healthcare infrastructures. In the early days of the epidemic, the HIV clinic was left to its own devices with a new patient cohort that no-one really knew what to do with. HIV clinicians learnt alongside their patients about what sort of care was needed and how it should be provided. By default they provided integrated, coordinated care based on patient preferences.
The epidemic has changed since then. Clinically, at least, the experience of being diagnosed today is very different from what it was 30 years ago and, with that, the needs of people living with HIV have changed too. The commissioning landscape has also changed. The Health and Social Care Act 2012 and funding squeezes mean that HIV clinicians are able to provide little beyond HIV-specific care.
To get back to the sort of service provision that people were used to, but in the context of contemporary healthcare infrastructure, there needs to be an attitudinal shift among providers towards shared, more collaborative care provision. Information sharing technologies need to be in place that support, rather than hinder this shift. Care coordination support needs to be available for those who need it. And newer technologies, such as those that can enable virtual clinics, need to be explored. But none of this can happen if it’s not commissioned.
The NHS Long-term Plan made a commitment to person-centred care. By definition that means that care is tailored to the individual. Commissioning needs to be tailored to the individual too. If the money doesn’t follow the patient, then the care won’t be able to either.
There are already some fantastic examples of integrated care provision where individuals have championed change, and been supported by forward-thinking commissioners. In Liverpool, a GP and a Community Nurse Specialist team provide care across a range of complexities in people’s homes for those who are unable to attend clinics in person; in Brighton a geriatrician works with the HIV team saving people from attending multiple appointments; and in one London hospital HIV and maternity services collaborate to provide an ante-natal clinic for people living with HIV, as an example of an HIV service responding to changing needs across the life course.
Transformative practices range from small, incremental changes through to ideas for much wider systemic changes. These adjustments could reorient an outdated healthcare delivery system towards the new challenges that will come from increasing complexity and multimorbidity. Not all of these changes will be universally implementable; a small clinic outside the major prevalence areas won’t have the same needs or capacities as a high-volume clinic in London or Manchester. Integration strategies are on a spectrum and it doesn’t necessarily take full system transformation to create effective change. Providers and commissioners everywhere need to be thinking about how to respond to the challenge of multimorbidity in their area.
HIV services have always been at the cutting-edge. Let’s make sure they stay that way.
This project was supported by funding from MSD UK as part of a support agreement.
Cheryl Gowar is Policy & Campaigns Manager at NAT (National AIDS Trust)