Innovation: Integrated Care

Singapore

AAI Domains:

• Independent, healthy and secure living (improving access to health care services, independent living)

• Capacity and enabling environment (use of ICT)

Ageing societies, even with a wide range of social innovations for active ageing over the life course, are likely to have increasing need for health and social care services. A major challenge around the world is providing the right level of care for people in the right place at the right time. This would be better for older people, their caregivers and for wider society in terms of better value for money with lower levels of high cost hospital care and higher levels of social care support for informal care.

Singapore has a population of 5.5 million people, faces a rapidly ageing population and has a mixed economy of provision in health and social care services that was characterised by older people having episodic periods of hospital care. In 2009, the Ministry of Health established the Agency for Integrated Care to oversee the development of new models of health and social care services from primary (general practitioner) and secondary (hospital) health care through home care, rehabilitation services and nursing homes in social care as well as palliative care.

The aim was to provide integrated care for older people organised on a geographically defined basis (Regional Health Systems), by improving linkages across health and social provision with an emphasis on improving transitions between different forms of care and to improve the continuity and quality of patient care.

A number of innovative programmes have been initiated such as the Singapore Programme for Integrated Care for the Elderly (SPICE) that used a multi-disciplinary team of health and social care professionals to provide a range of patient-orientated services in SPICE centres and in patients’ homes. This model of care was adopted and adapted from the US-based Programme for All Inclusive Care of the Elderly (PACE) indicating how policy transfer and development are global trends.

The Aged Care Transition (ACTION) project has seen hospitals develop teams to reduce delayed discharges for older people from hospital by developing and liaising with community care services. A National Electronic Health Record has provided professionals with improved access to individual patient records and enables them to have a complete picture of the patient’s journey through the care system.

Another key feature has been the development of integrated care pathways for older people who have experienced stroke, acute heart disease, type 2 diabetes, hip fracture or chronic obstructive pulmonary disorder. The drive towards improving and standardising the treatment of these major health conditions should enhance quality and ensure affordability.

All ageing societies face challenges in their health and social care systems and the integration of care is widely seen as a desirable policy goal. All reforms have intended and unintended consequences, face new challenges as old problems are addressed and can be difficult to implement. Singapore has not solved all of these problems but it has shown that integration is possible (though difficult) in a fragmented system in which change resistance and fatigue can make implementation difficult. Some of the key lessons from the post-2009 period include the importance of political ‘buy-in’ to the process, the need to invest before you see the returns, the importance of collaborative working across different settings and the importance of evaluation.

In terms of active ageing, the Integrated Care programme is relevant to improving access to health care services, independent living, the use of ICT (through the National Electronic Health Record) and improving mental well-being by reducing caregiver stress.

More information

International Journal of Integrated Care (PDF, 347KB)

The King‘s Fund (PDF, 6.3MB)