New Voices, New Power, New Ways of Working: Bringing integrated care to the National Health Service in England

This issue of Healthcare Quarterly features the third and final instalment in a three-part series developed by Ontario's The Change Foundation featuring international perspectives on health service delivery models that improve system integration and ensure seamless services and better coordination.Part one featured Chris Ham, chief executive of the Londonbased King's Fund think tank, and part two featured Geoff Huggins, director for health and social care integration in Scotland.In this issue, Helen Bevan, chief transformation officer of England's National Health Service, discusses the radical shifts she'd like to see in how we approach integration.T here is increasing agreement that integrating health and social services is an essential step in improving the health of citizens and the sustainability of healthcare.But Helen Bevan, the chief transformation officer of England's National Health Service (NHS), wants to see some radical shifts in how we approach that change.Bevan believes system change will not happen unless we take the emphasis off hierarchical power to focus primarily on collaborative teams that are unrestrained by corporate boundaries, freed from the constraints of permission and trained and enabled to respond to the needs that empowered patients to define for themselves.Her remarkable vision is being brought to reality in England, as Bevan explained to a group of health leaders from across Ontario at the Change Foundation's Toronto office in early 2018.Bevan was the third health leader from the UK to speak on innovative approaches to integrating care as part of a series organized by the Change Foundation with partners from the University of Toronto -the Institute of Health Policy Management and Evaluation, the Health System Performance Research Network and the Dalla Lana School of Public Health.Recent reforms at the NHS are part of an ongoing and longstanding movement towards integrated care that goes back to Margaret Thatcher's time as prime minister, and which Bevan has been involved in for 25 years.After all those years of re-invention, and in the face of crushing demand (the NHS sees a million patients every 36 hours), healthcare providers did not precisely welcome the news of plans to restructure again, Bevan told the audience in Toronto.But there was no choice, she said."When we looked at the trajectory of demand and we know what's happening to cost and we look at the numbers of people who experienced poor care in our system, we see that we have to change things."Or, as Chris Ham (who also spoke in the series), put it in a briefing note:It has been clear for some time that simply working our current hospital-based model of care harder to meet rising demand is not the answer.