EHMA Editorial

Abstract

We have recently come back from 3 days in Austria working with a group of managers, policy makers, and others from across Europe on the subject of integration in health. As many of you will have experienced, integration is a hot topic in healthcare at the moment. Both within countries and also increasingly at the European Union (EU) level, integration is often seen as a goal both within healthcare and between health and other sectors. By way of example, the recent announcement of the Commission’s Active and Healthy Ageing Innovation Partnership, a new vehicle for EU-wide action, has included models of integrated care as one of its themes, even though definitions of integration are notoriously difficult to pin down. Although a neat conceptualization of integration proved as elusive as you might expect, the similarity in many of the core issues facing the managers and policy makers meeting in Austria was very striking. All the countries represented were grappling with issues of working across organizational or sectoral boundaries, with developing appropriate policy frameworks to support integrated ways of working, and with scaling up successful pilot projects. Our 3 days of working together made it clear that ‘copy and paste’ of ideas from one system to another is rarely possible. That being said, challenge from colleagues in other countries and time to analyse the different blocks and enablers within different health systems were powerful tools for thinking differently about familiar systems and organizations. We spent part of our time in Austria on site visits, including one to a community-led facility for older people, which integrated services across the health and social care divide. In the main room of the day centre a dozen or so older people were sitting round a large table playing board games. Almost the first thing that you noticed was the smell, or rather the lack of it, although half of the older people there that day were incontinent. There was a book of photographs open on the table showing the older people involved in cooking, music sessions, and knitting: it was a picture of care that blurred the boundaries between family, community, and institution. The service had been set up largely through one senior nurse, who saw the need for better care for older people in that community and had built it up from scratch. As is common with many new services, the drive of one healthcare leader had been pivotal at its start. What was impressive about this service, however, was that it had moved well beyond the pilot project stage, developing into a financially sustainable way of providing care. The centre had also engaged a large number of volunteers from the local community, from teenagers on a gap year to music teachers. At a time when managers across Europe are dealing with budget cuts and reprovision of services, the risk is that the creativity and energy needed to build new innovative, integrated services, such as the one we saw in Austria, will be lost. But it is exactly at times like this that we need managers with patients at the very centre of their thinking and the ability to build relationships across sectors and organizations. If health systems are to respond to the unprecedented changes precipitated by an ageing population, rising demand for healthcare, and an ageing workforce then mediocre management is not an option. Of course, the visit left us with as many questions as it answered. Could you replicate this model on a larger scale? How would it work in a city like Brussels or London, where the sort of community cohesion and relationships that underpinned the community centre do not exist in the same way? But at the core of it was the challenge to create care for older people that you would be happy to see your own parents or grandparents receive, and that challenge has continued to resonate with many of us well after leaving Austria. The visit also raised important questions on how to grow and develop health managers (and health professionals in management roles) who have the skillset to develop integration across its full