Is the time now right to integrate health and social care?

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This year marks the 20th anniversary of the fall of the Berlin Wall, but as the former Health Minister Lord Warner noted at a debate at The King's Fund this morning, with a few exceptions the Berlin Wall between health and social care still stands.

Progress is being made in areas such as Torbay and Knowsley and they've also embarked on a radical route in Herefordshire. Chris Bull, chief executive of both the PCT and the county council, pointed to the potential for integration but cautioned against seeing it as an end in itself – joining up commissioning is about driving new means of delivery which reflect the needs of those using services rather than those who provide them. Meanwhile the senior civil servant responsible for social care in England, David Behan, claimed there was a need for a better understanding of why integration worked in some places but not in others.

Much of this could have been said 20 years ago. The big question now is whether we have reached a tipping point – a moment when factors will come together to bring about a step change. According to Lord Warner it needs political will at the centre and he was unsure whether that will exists.

Certainly the Green Paper on social care funding has moved this issue higher up the political agenda than it has been for many years. Politicians have been competing for attention with various schemes, some rather better than others. But, as was made clear by a number of this morning's speakers, any reform of funding must go hand in hand with service reform – people will not be willing to pay more for the same services.

There are a number of unanswered questions. First, how far will central government be willing or able to move to a system of national assessments and entitlements in social care?

Second, is it possible to devise a system of incentives – for both health and social care – which encourages the development of more community-based services, discourages unnecessary hospital admissions and fosters joint pathways and teams?

And third, where does the current, rather muddled picture of specialist commissioning, PCT commissioning, practice-based commissioning, social care commissioning and micro-commissioning (by individual patients and other users holding their own budgets) all fit together?

Behind this though looms the impending squeeze on health funding and the ongoing cuts in social care budgets. There is a danger that it could encourage a bunker mentality – we must all strive to make it a stimulus for reform.

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Mary Hoult

Comment date
14 November 2009
Well said, perhaps NHS IC for Health & Social Care is aleady working on it? or maybe QIPP is?

Alex Fox

Comment date
10 November 2009
If the DH is serious about joining up health and social care, perhaps the new Vital Signs must-dos for the NHS will include a compulsory indicator on joint commissioning or integrating care pathways across the joins?

Mary E Hoult

Comment date
07 November 2009
We do need more community based health/social care services, whoever provides them. With an ageing population local access is essential.

Phil Dickinson

Comment date
06 November 2009
Over the last 4 years in Southwark, we have been running 'leadership for integration' programmes in Southwark, focussing on the practical realities for individual managers and team leaders. Action Learning achieving real progress toward integration - and removal of the bunker mentality you mention. And I agree the reaction to pressure can be to revert rather than move forward with change.

Margaret Dangoor

Comment date
05 November 2009
Currently, the divide is focused on services and even more on professionals. For the average user and carer, the divide is primarily one of barriers. The proposals outlined in the Green Paper Shaping the Future of Care Together cry out for integration of health and social care. By the time the reforms are introduced, significantly more 'health' services will be provided in the community and will need to be supported by at least an equal growth in 'social' care provision. The division between what is 'health' and what is 'social care' will inevitably narrow, particularly as personalisation becomes embedded.

Mary E Hoult

Comment date
05 November 2009
Do you not think this is already happening? There is always key people who if you watch their movements the strategy shows itself. You only have to look at the 1997-2002 LEEDS HEALTH AUTHORITY CONSULTATION DOCUMENTATION I have a copy if required? to see the plan unfold. Key players all have key positions for this to happen now or in the next twelve months.

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