Chainmail may look ‘integrated’ but it’s still full of holes!

As a Radio 4 listener I often hear the “Thought for the Day” and admire how the presenter manages to get such a strong message out in such a short time. So the above title is my attempt to inspire a fresh thought about something that is being discussed by so many this day, “integration and competition”.

‘Integration’ in an environment of ‘competition’, is not about linking our services together, knitting them into a fabric that envelops our patient in a weighty, complex system that looks defensible to us but is still full of holes. Yet the concept of competition in the health care system is making many key players behave as if this were the solution. One reason for this may be, our lack of trust in the evidence base or our inability to see the evidence base at all, where is it? Another might be our misaligned thinking and behaviour. For example, the vision of our core purpose, to put the care, safety and health of our people first, is being challenged and fogged through political restructuring and the message that we need to achieve greater efficiencies. It is in some areas perceivably being replaced, possibly instinctively, with the drive to ensure the survival of established organisational forms or the power based that is occupied by them.

What ever the reason two fundamental challenges are obvious:

Firstly, if the evidence base isn’t transparent how do we make it so? How do we bring it in to the health care debate so that the energy in the current storm that is going on in the system can become harnessed, and used for constructive not destructive purposes?

Secondly, if irrational behaviour exists, how can we challenge it? How can we show and recognise leadership so that change can occur and genuine improvement in real ‘outcomes’ of value to the people who use and pay for our system can become the norm?

It is after all they who we should be integrating with and they who will be telling us if we’re winning the competition at the end of the day.

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