The Practicalities of Integration

There has been a widespread perception that health and social care tends to be too fragmented, and that services are too influenced by professional and institutional boundaries when they should be coordinated around service users’ needs.

As a result of this viewpoint the integration of health and social care has been on the agenda for years. It has been seen as the most promising way – in the absence of extra resources – to deal with financial problems and improve user experience. Successive governments have wanted everybody who uses both health and social care services to have services that work together to give the best care based on an individual’s personal circumstances. 

The creation of the Better Care Fund made collaborative working a necessity, and yet matters were not so simple. The practical barriers were considerable, and academic studies failed to produce compelling evidence that integration would generate cost savings. Yet the logic remains clear, and the emergence of Sustainability and Transformation Partnerships has reinforced the agenda. 

Both health and social care are likely to need some 3–4% real terms growth per year to deal with demand pressures and the costs of new medical technologies. However, funding levels for the period 2010 to 2020 have been and are planned to be nowhere near that level, leaving significant pressures to be met by savings. From an integration point of view, that financial landscape is a problem, because organisations may be forced back into short-term cost reduction measures and an opportunity, as integration is often cited as a means of improving efficiency.

This publication surveys the evidence to date, informed by many discussions with practitioners, to pin down:

• what integration means
• how it might be expected to improve efficiency and save money
• what problems make it difficult to achieve in practice
• what the solutions to the problems might be 
• how to assess and monitor progress. 

The Practicalities of Integration will be useful to managers and finance staff in the health and social care sectors, partner organisations and public sector bodies who work with them. It will also help anyone who needs to grasp the rationale for integration from a strategic or political point of view and understand the best way to take it forward.

This publication is only available online. 

The digital, online version is available as both searchable HTML and a bookmarked downloadable PDF of the publication that can be shared throughout your organisation.
Customers will need to register and login to CIPFA’s website to access the publication. Details of licensing arrangements for other categories of purchaser, which includes those organisations operating shared service arrangements, are available from CIPFA’s Publications Department.