News and Comment

Talk is cheap when it comes to integrating health and social care

Wednesday 15 May 2013

Yesterday’s revelation of plans to join up the adult health and social care system in England by 2018, means that in the last month representatives of all three major political parties have acknowledge the need to better integrate health and social care in this country.

Care Minister Normand Lamb and Health Secretary Jeremy Hunt jointly pledged to “end the institutional divide between health and social care”, by working with pioneer areas around the country to find out “what the barriers [to integration] are and remove them.” This follows less than a month after Labour launched an independent integration commission intended to report on how best to create a “whole care service”.

While such cross party consensus on this issue is to be welcomed, agreement around further integration in theory is nothing new; it has, after all been a recurrent goal of public policy since the 1970’s. If these recent announcements are to be taken seriously, the public will need to see this policy translated into practice, and that raises an altogether more contentious question: what form should integration take?

Integration is after all, a broad church. It can occur between organisations, or between different clinical or service departments within a single organisation. It can take the form of effective partnership working between health and social care agencies, or the more extreme approach of structurally integrating these agencies into one service.

Both of these overall apporoaches throw up a number of challenges for those involved in integrating services, especially around, infrastructure and IT, leadership, cost allocation and culture. And whilst overcoming these barriers will be crucial to the success of any more integrated health and social care ‘system’ in future; our experience of working on integration projects on the ground tells us that focusing on such issues to the detriment of the ‘patient experience’ is foolhardy.

Understanding the patient journey and their requirements to support self management is essential if integration is to deliver the ambitious benefits it aspires to. Best practice involves working closely with patients to ensure their perspective is fully recognised and in some cases, solutions are being created through co-production.

As we’ve blogged about previously, our work in Hounslow and Richmond showed us not to underestimate the public’s appetite for integration, innovation and change, and this is corroborated by the emergent findings of work were currently doing in the North West, London and beyond. Integration initiatives that ignore the voice of patients and the public, and instead focus solely on trying to ‘keep people out of hospital’ or ‘reduce their levels of service’, are destined to be less successful than they otherwise could be.

We remain optimistic that in the coming years integration will go from something that is talked about, to something that increasingly happens. After all, the driver for more integrated care – changing demographics, increased levels of long-term conditions, and more complex conditions – are things that are here to stay.

In our inaugural Changing Times interview on the OPM blog, Matthew Taylor of the RSA called integration “the biggest urgent, solvable problem faced by public services.” This Friday, we’ll hear from Lord Victor Abedowale who reminds us that the challenges we face in health and social care “are partly due to the success of the system.” For the system to continue to be successful in future there seems to be agreement that some form of integration is needed. The question remains, which?