Integrated care in Northern Ireland, Scotland and Wales: Lessons for England

At a time when policy-makers in England have made a commitment to bring about closer integration of care both within the NHS and between health and social care, what can the health and social care system in England learn from the experiences of the other countries of the United Kingdom?

Integrated care in Northern Ireland, Scotland and Wales examines the context in which health and social care is provided; identifies policy initiatives that promote integrated care and the impact of these initiatives; and considers the barriers and challenges to achieving integrated care. The King’s Fund commissioned authors in each of the three countries to write a paper considering these issues. The authors reflect on what England can learn, drawing on their own experience of what has and has not been achieved.

The report concludes that structural integration of health and social care will not bring benefits in itself but must be accompanied by other changes.

Key findings

• Northern Ireland has had integrated health and social care since 1973 but there has always been a commissioner–provider separation throughout this period.
• Scotland has had an integrated NHS structure since 2004 when the commissioner–provider separation was ended and unified health boards created but local authorities continue to have responsibility for social care.
• Wales has followed the example of Scotland since 2009 with the creation of unified local health boards and again local authorities continue to have responsibility for social care.
• The structural integration of the health and social care system in England will bring few benefits unless it is accompanied by other changes, including:

1. a willingness to challenge and overcome professional, cultural and behavioural barriers
2. action to share information both within the NHS and between health and social care
3. organisational stability to avoid the distractions and delays that occur when structures are altered frequently
4. a willingness to provide financial support and flexibilities to enable the introduction of new models of care.

• Organisational stability and leadership continuity are important facilitators of integrated care.

Policy implications

• Coherent policies should be developed to promote and support integrated care – including a national performance framework and a single outcomes framework.
• Governance arrangements should be established to enable different organisations (especially local authorities and NHS bodies) to work together to develop joint strategies.

Integrated care should be a policy priority for government as a whole.