Planning and delivering integrated health and social care: guidance

1. Is integrated from the point of view of service-users

People access and require care and support in all sorts of ways and no-one should be disadvantaged because of where and why they enter the health and social care system. A person should experience seamless care, which consists of the right care and support whatever their needs, at any point in their care journey.

Trust, transparency and respect between professions, organisations and people accessing services are essential to making this principle real.

People’s health and wellbeing and the support they need will change over time. Many people live with conditions that change day-to-day, some that will progress over time and some that are difficult to predict. The circumstances of people’s lives change too. This means health and care services need to be able to respond flexibly.

People may need to be supported to make decisions, in order to be in control and manage their health and wellbeing. This means teams need to have the time and skills to work with people, listen to their views and support them to make choices. Independent advocacy services should be available to people who require them. People will need accessible information, to be made aware of the options available to them and may also require communication support. This will help them to have conversations with those providing and delivering services that are focused on the outcomes that matter to them.

People should not have to tell their stories repeatedly. With a person’s consent, information about them should be shared across organisations and professions in a proportionate, secure and sensitive way.

Once decisions have been made, people should be confident that staff have the powers, resources and relationships they need to ensure integrated care and support is provided. This should happen regardless of which professions or organisations are involved in delivering this.