General information

The care landscape is changing. After a hospital admission, people return home as soon as possible. Also, elderly people often remain at home instead of going to a care home or nursing home. People are now receiving more and more care, treatment and support in their home environment. This means that some of the tasks are shifting. Certain treatment and care tasks that are normally provided by the specialist and the hospital are now being handled by the general practitioner (GP) and the district nurse. They are playing an increasingly important role. It also means that informal caregivers are becoming more important. Local councils play an increasingly greater role in support at home as they provide services in their municipality.

In addition, more collaborations and intermediate forms of care are being created. The government and health insurers are focusing on the shift from hospital care to primary care. The GP, medical specialist and other care professionals are working together more closely.

What is integrated care?

People with complex needs, who receive care and support often have to deal with different care providers, as well as informal caregivers and sometimes volunteers. All these people together form the ‘care network’ of the client.

It is important that everyone in the care networks works well together to make sure that people experience care in a coordinated way. This is what we call ‘integrated care’.
Consider, for example, a client's care network with an informal caregiver, GP, physiotherapist, district nurse, domestic help, medical specialist, the daytime activities and the pharmacist. The size and composition of the care network differ per person.

Why does the Inspectorate supervise integrated care?

Care networks became a topic for our Inspectorate due to the transition of health care in The Netherlands in 2015. These changes in the care landscape create new risks. For example, in terms of quality and safety of care. Or overburdening of informal caregivers. Caring for people in their home environment often involves vulnerable target groups.

Vulnerable Target Groups

For example, they include elderly people with dementia. But also children who receive specialist medical care at home. Providing care in home environments can also involve additional risks. For example, due to the client's living environment. Or because of care relationships and the use of medicines.

It is important that everyone in the care network works well together to ensure that the client receives care in a coordinated way. This may seem self-evident, but it is not always the case. Someone in the care network must oversee the care the client receives. That person is responsible for coordinating the care network.

By supervising integrated care, the Health and Youth Care Inspectorate would like to:

  • improve the quality and safety of the care for people with complex needs, living in their home environment;
  • promote cooperation and cohesion in care networks;
  • improve the collaboration with local supervisors in municipalities.

What does supervision of integrated care in home environments entail?

We are adjusting our supervision to the changes in the care landscape. We therefore examine two key components:

  • the quality of care provided by individual care providers or organisations;
  • the collaboration in the client's care network.

We inspect care networks on two levels; the network of the client level and the network on the local or regional level. The client level, and thus perspective of the client, is our starting point for inspection.

Inspection framework for integrated care

The Inspectorate developed an inspection framework and a working method for supervision of integrated care in home environments (see figure below).  When supervising integrated care, we focus on four central themes:

  • Is the client receiving care that meets his/her needs?
  • Is the client receiving sufficient support from the various network partners and do the various care providers in the care network collaborate?
  • Do the various care providers collaborate with the (key) informal caregiver(s)?
  • Does the care network provide safe care?

During our inspection we interview a number of clients that belong to our target group. We ask the client to list the different care providers in their personal care network. After we receive consent, we interview key members of their personal care network. Interviews are for instance with the informal care giver, the general practitioner, the district nurse, the medical specialist, or other care providers. We ask these key members about the care they provide and about the collaboration in the client’s care network.

We analyse these results and formulate a preliminary conclusion about the collaboration in care networks on a local or regional level. We then discuss our findings with the professionals involved in the data collection. After this discussion, we report our final conclusion to the managers and board members of various organisation that provide care in care networks.

We also present and discuss our findings at the national level to or with policy makers and other stakeholders.

Collaboration with supervisors of social services

In supervising integrated care, we collaborate with other supervisors of social services. The Health and Youth Care Inspectorate is responsible for supervising the quality of care. Local authorities are responsible for offering support to citizens. They are also responsible for supervising that support. When it involves clients who receive both care and support, local authorities and the Inspectorate cross paths.