Integration Health and Care Experience Profile 5

Healthwatch Ealing and Healthwatch Hounslow produced a Health and Care Experience profile about a woman with multiple health conditions, including recent experience of care for a cardiovascular condition.

This was part of a project led by Healthwatch England and NHS England to develop a qualitative methodology as part of the Local Integration Index. Eight local Healthwatch piloted this methodology by focussing on particular local groups with experiences of care across several health and care services. This methodology can be used to ensure people’s experiences of integration are used by local systems to track how services are working together locally.

A literature review was conducted alongside a comprehensive data analysis, a series of focus groups and semi-structured interviews, and a meta-analysis to capture the theoretical pathways of integrated care for women suffering from cardiovascular issues as well as how these pathways are being realised and experienced. The data shows that women in Ealing and Hounslow with this complex health status were frequent users of a large range of different emergency and elective secondary care services.

 In conjunction with the views and experiences of women that shared similarities with this experience profile, the evidence suggests that holistic care pathways must be effectively structured with accessible prevention and management strategies in place, in order to improve the health and wellbeing of these women. Although a lack of communication, poor service provider coordination and a lack of holistic care were regularly cited by individuals, Ealing residents were notably more satisfied with the level of care that they had received.

The analysis also uncovered health inequalities with high rates of emergency admissions coming from those living in the most deprived areas, significantly higher rates of Hypertension and Coronary Heart Disease in of women of a BAME ethnicity and disproportionately more women of a BAME ethnicity with 5 or more long-term health conditions including a heart condition.

Local policy around cardiac pathways and integrated pathways of care was limited and should therefore be built upon. However, the evidence from this research points toward initial inaccessibility to services and a lack of prevention and management support as significant contributory factors to the complexities of this cohorts' health and wellbeing and not necessarily the acute and chronic care services.

This paper outlines the visions and ambitions of the NW London region as well as each local borough pertaining to the improvement of care for this experience profile, alongside recommendations on how to both further develop the methodology of this research for future use focused on tracking whether the improvements in process or planned in these boroughs are having a positive impact on patient’s perceptions and experiences of their treatment, and how the level of integration and coordination of the health and social care systems in Ealing and Hounslow could further support women with multiple long-term health conditions including a heart condition.