Spinning plates or perfect jigsaw?

The case for integrated care is unassailable with an ageing population living with long-term conditions (multimorbidities), needing continuous care and treatment delivered across settings and providers. Integrated care systems have the potential to improve care access, the quality of care as well as continuity of care, with users at the centre of the care system, thereby overcoming the shortcomings of the traditional model of single medical speciality treatment and care focused on single organ disease (Barraclough et al, 2021; World Health Organization, 2018).

The UK is not alone in recognising the benefits of integrated care (Carrigan et al, 2023), but its implementation has not been without challenges, as many readers probably know. A qualitative interview study of 28 managers, commissioners and clinicians across various settings in the West Midlands and the South East revealed the challenges which needed to be managed to deliver integrated care within the anachronistic NHS structures, and established fragmentation between services (Litchfield et al, 2022). An in-depth study of the implementation of integrated care in Switzerland identified payment mechanisms, as well as the territorial behaviours of some healthcare professionals in the face of newly emerging roles, as impediments to good integrated care (Carron et al, 2023). Similarly, a Dutch-controlled cohort study revealed the real life challenges of implementing an integrated care pathway for COPD and asthma in the face of logistical complexity, which highlighted the need for the streamlining of the existing provisions, as well as the need to enable those of low socioeconomic status and limited literacy (Witte et al, 2023).