9 February will see the CIPFA/HFMA summit on health and social care integration providing a suitable point at which to reflect on where we have come from - and how far there is still to go in England to integrate services to both improve value and provide more joined-up service provision for the public.
At the turn of the century there were pooled budgets and joint funding agreements between health and social care, but they tended to be seen as a somewhat separated off area of activity typically restricted to particular specialities, notably mental health, equipment and adaptations, and agreements emerging from changes in responsibility for people with learning disabilities. Whilst many were in favour of working together, integration was rarely seen as a strategic aim.
2015/16 was the first year of the Better Care Fund (BCF). It can be argued that this was little more than a politically expedient way of redistributing funds around the system, and that the way it was set up provided more reasons for dispute than for cooperation. However, the requirement to work together on a broader canvas, making decisions on how to use £5.3bn BCF monies, was a clear signal that the government was serious about progressing integration.
As the 44 Sustainability and Transformation Plans (STPs) were prepared during 2016, it became clear that these would become the primary driver of integration between health and social care, with the potential to bring far more NHS and local government spending under a joint framework. STPs appear likely to emerge as the practical vehicle for the government's requirement that during 2017 all health and social care economies will produce plans for full integration by 2020. Meanwhile the regional devolution – though the agreements to date don’t often incorporate health spending – is a potentially complementary change agenda.
A possible stage five might arrive following on from that 2020 vision if STPs deliver on health and social care integration, and also start to incorporate all those services that are critical to the wider causal factors behind health outcomes: housing, education, welfare, environmental conditions, economic trends and access to leisure and jobs. And whilst structural vehicles such as accountable care organisations are being developed, it seems unlikely that a national blueprint will emerge, but rather success will be achieved by areas with the vision and leadership to move away from historical, organisational patterns of working into a world that is based much more closely around the patient and service pathways.