Across the world, countries are attempting to join together patchworks of fragmented primary, community, hospital and social services into more coherent health and care systems. In the English NHS, groups of local healthcare providers are attempting to reduce duplication between services, to make better use of staff and resources, and to improve coordination between related services. The opportunities for improvement are enormous. If we ensure access to high quality primary care services, we solve in a stroke the problem of inappropriate attendance and hospitals’ accident and emergency departments. If we ensure that patients with renal failure attend their community dialysis appointments, we avoid the huge costs of emergency dialysis treatment. However, it is also true that progress in unlocking these efficiencies has been slow, in part because of the need to coordinate between many different organisations with competing interests and priorities. This presentation highlights some common features of highly effective integrated systems which have allowed them to integrate care across services. These include the leadership, vision and culture of these local systems as well as their financial and contractual ‘wiring’ and their infrastructure to support learning and improvement.
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