Background briefing on Health and Social Care Integration

What is integration?

Health and adult social care services in England have traditionally been funded, administered and accessed separately. Health has been provided free at the point of use through the National Health Service, whilst local authorities have provided means-tested social care to their local populations.

It is argued that patients with both health and social care needs are badly served by the current model, and that by integrating the NHS and local authorities, the patient can be put at the centre of how care is organised.

Policy on integration has focused on delivering care outside of hospital, instead delivering care as close to the patient as possible, either at home or in their community. It has also sought to reduce problems caused by the ineffective interaction of health and social care, such as unnecessary hospital admissions and delayed discharges.

Why is it important?

Demographic trends, such as an ageing population and increasing life expectancy for those with multiple, long-term conditions, mean that there is an increasing number of patients with both health and social care needs.

As well as improving the experience for the patient, it is argued that integration can save money by cutting down on emergency hospital admissions and delayed discharges. This is particularly significant in light of current funding pressures for the NHS and local authorities, although the scope of potential savings has been disputed.

What challenges are faced when integrating services?

There are a number of challenges faced by successive Governments attempting to better integrate health and social care. These include:

• Different funding incentives for the NHS and local authorities
• Different funding models - free at the point of use vs. means-tested
• Challenges integrating different workforce cultures
• Difficulties implementing effective information sharing
• Different inspection frameworks
• Other Government policy priorities competing with the integration agenda
• The cost to NHS bodies and local authorities of integrating services
• Problems with joint-Departmental oversight

These challenges, and Government attempts to address them, are explored further in this briefing paper.

What is the Government doing on integration?

Recent Government policies to promote integration have included the creation of Health and Wellbeing Boards, local strategic planning forums with representatives from health and social care services, and the Better Care Fund, a pooled budget between the NHS and local authorities, to which the Government has committed £3.9 billion in 2016/17. There have also been a number of smaller, pilot projects to improve integration.

Many of these policies are relatively new, and so detailed evaluation of performance is often limited in its availability. However, their impact so far, and comment from those in the health and social care sectors is examined in this briefing paper. In the case of the Better Care Fund, the policy has not succeeded in reducing the number of emergency hospital admissions and delayed discharges, which have continued to rise in recent years.

Integration is also playing an increasing part in the Government's devolution agenda - particularly in Greater Manchester - with health and social care powers being devolved to local areas.

What are the devolved administrations doing on integration?

The four UK nations have taken different policy paths with regards to integration. Scotland and Wales have both passed recent legislation promoting integration, including moves towards fully integrated health and social care commissioning in Scotland. Northern Ireland has had an integrated health and social care system since the 1970s.

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