An interstellar journey to integrated care

An interstellar journey to integrated care

On the 20th April 2024, just two days before the ICIC24 conference kicked off, NASA’s Voyager 1 spacecraft returned data to Earth for the first time in five months[1]. Voyager 1 and its twin spacecraft Voyager 2 have been on an interstellar journey for more than 40 years. However, in November 2023, Voyager 1 stopped sending readable engineering data back to Earth. Luckily (or purposedly?) the Saturday before the start of the Conference, Voyager 1 started returning data to Earth once again.

If there is a term or a metaphor that we have used massively at ICIC24, that is journey. In the past, we have used different metaphors to capture the process of adopting care, which is person-centred, coordinated and continuous, but journey has become increasingly popular. In ICIC22 the term appeared in the Conference Programme 6 times; in ICIC23 8 times; and this year, the word journey appeared 13 times in the different titles of the sessions, workshops and the presentations. Most importantly, it was used repeatedly in our conversations.

Countries around the world have been on a journey to integrated care, and at ICIC24 we have had the opportunity to hear about some of these: some for almost as long as the NASA spacecrafts, others which have just passed their adolescence, others just newborns or even one or two which are still yet-to-be. Many ICCI24 sessions included presentations that reflected the different processes worldwide, from Canada to Australia, New Zealand, China or Singapore. The journey in Northern Ireland was presented to the attendees in the first Plenary of the Congress. A good-size delegation from Estonia attended to listen, learn and think innovatively.

In particular, at ICIC session 11A[2], entitled “Learning from the hard reality of trying to create integrated care”, we took stock of the 30-year journey in England[3] and Scotland or of the more than a decade-long in Catalonia, Wales and the Basque Country.

Reflecting on the experience from their own journeys, at some moments speakers seemed to describe it as a wild adventure into the perils of the jungle and the unknown. On occasions, it sounded as a conquest or climbing expedition. Sometimes discourses depict integrated care as a holy land, that once we will get there, we will live happily for the rest of our lives. Rather than a journey, one feels it is a pilgrimage. Indeed, at times it might have had a bit of all these things, it might have seemed an adventure, a pilgrimage or a conquest.

And journeys can also fail as ships sink, spaceships explode or expeditions get lost. Take the Titanic, for example, and many delegates may have visited the exhibition in Belfast. So, indeed there can be “epic fails” in integrated care, which will be the focus of a forthcoming webinar organised by IFIC Australia will precisely revisit those failed experiences[4].

[1] Voyager 

[2] Session 11.A Learning from the hard reality of trying to create integrated care

[3] Tsiachristas A, Vrangbæk K, Gongora-Salazar P, Kristensen SR. Integrated care in a Beveridge system: experiences from England and Denmark. Health Econ Policy Law. 2023 Oct;18(4):345-361. doi:10.1017/S1744133123000166

[4] IFIC Australia Webinar – ‘Epic Fails’ in Integrated Care – Learning from our Failures 

But underneath the unadorned messages about the harsh reality of trying to create integrated care, participants at the mentioned session 11A reflected a sense of worthiness and achievement. They made the road by walking, as Spanish poet Antonio Machado said:

Walker, your footsteps
are the road, and nothing more.
Walker, there is no road,
the road is made by walking.
Walking you make the road,
and turning to look behind
you see the path you never
again will step upon.
Walker, there is no road,
only foam trails on the sea.

Therefore, the journey for Voyager spacecrafts and for countries continues. We are not yet there but every step we make, we get closer. Sometimes we might get it wrong, face mammoth (policy, political or contextual) challenges or just a small chip error might make our computer systems crash as happened with Voyager 1, but from all these situations we can get back on track. NASA engineers made it possible from more than15 billion miles away.

So, the ultimate message from session 11A participants was to keep up your faith on integrated care, or in the words of Igor Zabala, the Basque Country rep – don´t stop believing!

Actually, isn’t it a wonderful coincidence that this -don´t stop believing- is the title of a well-known song composed by the US rock band called…Journey!

Arturo Alvarez
Head of Integrated Care Solutions
International Foundation for Integrated Care (IFIC)