Joined-up care: the next step

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Integrating health and social care has long been a goal of governments. But the latest proposals are unlikely to go far enough and more radical measures may be needed

This week’s announcement of new ‘integrated care pioneers’ is to be welcomed – but the commitment to making joined-up health and social care the norm by 2018 may prove challenging.

Developing closer joint working has long been a policy aspiration – at least as far back as the 1960s.  However, the current financial context and the potentially fragmented nature of the new health structures could make integration even more important but even harder.

Ever since the 1940s, we have had a system that tries to distinguish between people who are ‘sick’ (who are seen as having ‘health’ needs met free at the point of delivery) and people who are ‘frail’ or ‘disabled’ (who are the responsibility of local authority social care and who are means-tested and charged for their care).

This distinction may once have made sense – but it feels increasingly unfit for purpose in an era of long-term conditions and with a rapidly ageing population. People just don’t live their lives according to the categories we create in our welfare structures – no matter how practical these categories may look on paper.

Recognising the need to change is half the battle, but it’s less clear cut what government and local ‘pioneers’ can do in response.  Many of the tools that might help are already in place – a single regulator, an annual joint assessment of needs and significant experience of joint management, pooled budgets and multi-disciplinary teams.

Whether there is appetite for a more radical questioning of the health and social care divide itself remains to be seen – but a genuine solution might need something significantly different if we are to make further progress.

One option would be to fund long-term care for older people in the same way as we fund the NHS, building this in to the current Care and Support Bill.  Another might be to transfer responsibility for health care commissioning to local government, leaving some of our current NHS structures intact as provider organisations rather than commissioners and making future services more locally accountable.

Unlike previous policies, such options would mean more fundamentally unpicking the legal, financial and organisational division between health and social care, rather than asking local partners to find ways round these national, structural barriers as best they can.

With public services facing significant pressures, it remains to be seen whether we can be bold enough to grasp these opportunities, or whether such options are still too radical to be feasible in practice.

Jon Glasby is professor of health and social care and director of the Health Services Management Centre at the University of Birmingham. See here for further details of HSMC’s research into partnership, collaboration and integration

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