Championing Integrated Care in the Face of Fragmentation

By Dr Sarah Barry, Royal College of Surgeons in Ireland

In a time when division and fragmentation are increasingly shaping our world, the call for integrated care is more critical than ever.

In his latest book ‘Who is Government? The Untold Story of Public Service’, Michael Lewis endorses the value of mission-led civil servants who engage with the necessary detail to positively impact on public life. This echoes surgeon and author Atul Gawande who has long argued that ‘incrementalists’ such as GPs and Allied Health Professionals are the real heroes delivering relationship-based care in response to modern day population health challenges such as chronic disease, mental ill-health, ageing and frailty. Conditions our health and care systems are not well designed to address and to which the radical idea of integrated care responds.

This week a group of such ‘radical incrementalists’ gathered in Dublin for the All-Ireland Conference on Integrated Care, with over 300 delegates attending from both the Republic and Northern Ireland. They are a diverse group who include health and social care practitioners, policy makers, health system administrators, patients, academics and advocates.

They are practical changemakers working from a vision of integration, connection and care at variance with recent geopolitical pushes for hardened borders, isolation, individualism and top-down dictates aimed at breaking-up systems; pushing for ever-greater fragmentation of populations and shared values. In contrast those working for integrated care value and invest in the long-term, engage with the detail and believe in the slowly emerging benefits of an integrated approach to care, understood in the broadest of terms.

How we care formally through our health and social care systems is an important instance in public life for upholding a set of values that put the person, whoever they may be, at the centre of endeavour.  Across the island of Ireland the policy response to fragmentation is an integrated model of care underpinned by a set of values to deliver a whole system approach that puts the person first. This approach translates into quality relationships between patients, clinicians, administrators and the public, drives technical solutions that ensure linkage of important resources such as our health records, and establishes governance arrangements, strategy and planning that can ensure decisions are made with, and as close to the patient, carer, service-user or practitioner as possible.

In the Republic this is much of the rationale of Sláintecare, the national health reform policy and programme. In Northern Ireland, the Integrated Care System established in 2024 aims to work through new Integrated Partnership Boards with system-wide planning and collaboration. Both strategies are based on an integrated model of care and service delivery within a population health approach. These drives for integration are indeed radical in nature. They require transformational shifts in how we currently think, work, plan and allocate resources, in how we manage our care workforce and financing. They require us ‘getting out of our own way’ to enable innovation, appropriate risk and learning. They ask of us the courage to do differently.

As is normal at conferences, the All-Ireland Conference on Integrated Care delegates met to share evidence, reflect and learn together as a community of practice. But it is also very important these people, many of whom work quietly in their local communities and settings without fanfare, are encouraged and supported beyond that immediate community. That the values they work from are championed and called out in new spaces. That decisions are made at every system level to ensure their efforts are embedded into sustainable and scalable systemic changes as recommended in the policies noted above.

We need integrated care champions at all system levels and across different government departments, in the broader public sphere, on the airwaves and through network channels. We need greater public engagement, understanding and belief.

Let’s champion the slow, long-term and programmatic work of integrated care as a practical path against fragmentation. Let’s encourage the implementation work of good people all over the Island of Ireland who in their own hopeful, sometimes dogged, but also courageous ways are progressing an integrated and caring vision of society in their local settings, through the systems they use or seek to improve, and in a myriad of disciplinary, professional and experience-driven domains.

They work in new multidisciplinary teams, try out experimental roles, responsibilities, new methods and models. They are doing the hard yards to get the Health Regions in the Republic and the Integrated Partnership Boards in Northern Ireland going. They engage in patient panels or drive innovative co-designed research models. They believe that integrated care is a common good that can deliver better outcomes for all. They believe this is something worth fighting for, now more than ever.

Only through integration can we ensure that everyone receives the comprehensive, coordinated care they deserve, regardless of background or circumstance. In the face of growing division, the fight for integrated care is a fight for a healthier, more united future. You are invited to champion too!