Integrated care systems (ICSs), partnerships of organisations that come together to plan and deliver joined up health and care services, were established across England on 1 July 2022.
Pauline Shepherd points out that health and social care has always been integrated in Northern Ireland, although they still work to some degree in silos.
Among our interviewees, there’s a general agreement that, in theory, integrated care boards are a positive step forward and greater integration between the NHS and social care providers would be a good thing. However, there is some scepticism among our interviewees as to how – and how quickly – integrated care can be achieved.
Sometimes integrated care happens because it has to, for example in the care of young people, but can be tokenistic. However, they believe integration is not really happening on the ground in any meaningful way, generally because of the different cultures in health and social care and because initiatives are too NHS focused.
“Plans to join up services go back decades,” says Yasmine John, “However, the number and the frequency of new policies on integration make it clear this challenge still remains. In my experience, when I’ve worked within NHS hospitals and you must liaise with a local authority when a patient’s discharged, there’s no integration or co- ordination whatsoever, particularly if an individual has multiple health and social care needs. They tend to be against each other in some respects due to resources, budgets and capacity. Not everywhere, but in many places that I’ve worked in over the past 25 years, it’s very much health blaming social care and vice versa. I haven’t seen a lot of integration whatsoever. It’s an impossible task for many reasons and still not well developed.”
Which, if any, of these statements best reflect how you feel about integrated care?
Our survey showed a mixed picture: around a third of respondents are positive, with 22% having seen benefits from integrated care already, and while 13% have not seen benefits yet, they think it will help provide more joined up care in the future. Meanwhile, around two thirds are more sceptical: 6% say integrated care is not happening in any meaningful way right now, 13% say social care is already being left out of integrated care, 23% think integrated care is just another area where the NHS will dominate and take most of the funding – a view that tends to be shared within the children’s sector and the smallest companies - while 25% say we won’t have proper integrated care until we start working as part of multidisciplinary teams.
There is also a belief among 39% of people surveyed that better integration across NHS and social care would make it easier for care providers to be more economically sustainable.
Barriers and levers to integration
Good communication between services will be key to successful integration so that everyone, whether they work for the NHS or a social care provider, feels like they are working for the same outcomes.
Relationships between local authorities, the NHS, the voluntary care sector and independent care providers need to be in place. But Adrian Hayter can’t clearly see a place for social care providers to be part of the conversations at Integrated Care Board (ICB) and integrated care provider (ICP) level. “It’s not mandated enough. It’s not clear enough for people to be at the table and build those relationships. If clearer structures at the ICP level are put in place now, it will make the decision making at a later stage much easier around how money is spent at ICB level and how care provision can then be, making sure that the voice of the big NHS providers doesn’t always trump everything else,” Hayter says.
Different technology systems in health and social care are also barriers to integration.
“This is, however, a part of regulatory reform by CQC, and multidisciplinary teams are a key factor in social care reform and have been for many years,” says Charlotte Rowe, “We continue to advise care organisations on the regulatory reforms which will be impacting the sector throughout the next 12-18 months, including integrated care.”