Five questions with Dame Donna Kinnair

FIH: When did you first hear of the concept of integrated care?

DK:  I grew up in family which used integrated care. My father who was a chronic asthmatic managed most of his life with a combination of traditional and alternative clinical interventions. I remember when he started using herbal remedies I saw more of him as he managed to keep out of hospital.

My interest in integrated healthcare really grew when I worked as a community nurse in the Caribbean and in my visits to both South and East Africa I have witnessed first hand, how they used a combination of traditional interventions and herbs and medicines to manage a range of conditions, often with good effect.

FIH:  How has this influenced your work?

DK: I am an ardent believer in patient autonomy and this does include the absolute right to participate in managing your health. In my view it is the role of clinicians to work in partnership with patients to manage their healthcare while ensuring that clinical evidence, when known, is provided to patients. I have worked as a nurse with a range of patients with terminal conditions who have retained a level of autonomy and well-being by engaging actively in integrated care.  

FIH: Would you like to see more complementary approaches brought into the NHS?

DK: I don't know that we have to bring too much into the NHS. It can sit alongside. Recently I've been working with someone who has been hiccupping continuously. They've been tried on codeine and all sorts of drugs which didn't make any difference. Finally she went to a homeopath who listened to her - I've no idea what they prescribed, but the hiccups stopped and she hasn't consumed anything unhealthy. The NHS isn't always the answer.  I personally use acupuncture from time to time.

We're in a different era now - the NHS cannot continue to provide care without a strong self-help component.

FIH: Do you see cost to users as a problem?

DK:  People are making choices all the time about what they spend - they decide whether they want to buy tea or coffee, they decide whether they want to spend £30 on an evening in the pub or on a complementary therapy.  We need to ensure that we do not perpetuate a culture of dependence, but it's surprising how people manage when they have to.  I would say my parents were pretty poor when they arrived in the UK, but had exposure to a self-helping health tradition and education. Education is open to all of us, and is very important to the self-care agenda.

FIH: What's your view about the challenges to an integrated approach?

DK: You get problems where people perceive it as a threat - many go on about the lack of scientific evidence in say, homeopathy.  But a lot of medicine started out as intuition or hunch until we identified the evidence base.  When John Snow removed the handle of the Broad Street pump and stopped the cholera epidemic, he was acting on a hunch.  We try it out and see if it works - it isn’t rocket science. Of course evidence based science is great, but the path to that evidence isn't always as clear at the beginning as it is with hindsight.   And it doesn't mean that you shouldn't look for mitigation outside that evidence base.