The integration conversation


by Dr Eleanor Roy, Health and Social Care policy manager, CIPFA

Have you ever looked at two people and just known in your gut that they should be together? It’s the stuff that sitcoms are made of – two friends that are so perfectly in sync that everyone around them agrees they should just make it official, but no one quite knows how to make it happen.

Welcome to the conversation around integrating health and social care – two things so inextricably linked that for them to be so separate doesn’t make sense. 

While it feels like we’ve been having this conversation for decades, it’s more salient now than ever. For those working in health and social care, the challenges are greater than ever before. Demand is high, resources are scarce, and money is not being directed where it’s needed most. The phrase ‘doing more for less’ can seem clichéd, but the fact of the matter is that the pressure leaders are under to deliver exactly this is immense. 

In a public sector culture shaped by transformation, efficiencies and austerity, it stands to reason that integration of health and social care will feature prominently. While it won’t miraculously transform patient care, generate huge savings, and create a financially sustainable future all on its own, it paves the way for a truly place-based approach. This is turn allows the sector to deploy resources in a way that improves outcomes for patients through new modes of service design and delivery – irrespective of which ‘pot’ the money originates from. 

Political rhetoric is leaning more heavily than ever towards the integration agenda. The emergence of sustainability and transformation partnerships and integrated care systems in England sends a clear signal about the intended direction of travel. The NHS Long Term Plan re-emphasises the government’s commitment to integration. However, while grand proclamations look great on paper, these measures do little to address the practical finance and governance challenges presented by the overall ambition.  

We have reached a stage where rhetoric is no longer enough. The system is bursting at the seams and creaking under the weight of media scrutiny, regulation, and rising public expectations. Now is the time for solid, visible action. Integration is the path and there is no turning back. 

This article first appeared in Spreadsheet.

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