Creating the right sort of ship to achieve integrated care: A response to recent commentaries

We welcome the opportunity to respond to the interesting and insightful commentaries provided by Rod Sheaff1 and Axel Kaehne2 on our editorial Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?3In this editorial, we reflected on whether the multiple attempts to improve integrated care for older people living with multi-morbidity were getting to the root of the problem, or merely shuffling the deckchairs while the ship is sinking to use the Titanic analogy. Our argument was that initiatives that focused on fixing parts of the system were more likely to be shuffling the deckchairs. In order to really stop the ship from sinking, our proposal was that we needed to focus on the following key issues: making sure that attempts at integrating care are firmly centred on older people themselves and their individual aims and expectations; paying attention to the processes of implementation and taking account of the complexity involved; and adopting co-production approaches that enable collaborative working amongst all the relevant stakeholders, with patients and their carers at the centre.