Integrating Health and Social Care

Source: Office for National Statistics, National Records of Scotland, Northern Ireland Statistics and Research Agency 

Integration is a broad term and definitions vary. Recent policies across the UK that have encouraged greater integration between health and social care have tended to define it as care that is person-centred and coordinated across care settings. Integration can be within different healthcare settings (e.g. primary and secondary) or between health and social care services. Better integration between health and social care has been put forward as a way to reduce costs, relieve pressure on services and improve user outcomes and experiences.

Integrated care policy in the UK has a long history. From case management in the 1980s, through inter-agency working in the 1990s, to integrated care pathways in the 2000s, successive governments have tried to bridge the divide between health and social care. All four UK nations have committed to better integrated care. However, assessing the effectiveness of integration schemes is difficult. Evaluation tends to focus on whether integration has relieved pressure of services, such as reducing emergency hospital admissions, which data suggest is not routinely achieved. However, integration may improve user outcomes and experiences, but data to assess these are not consistently collected.

This briefing outlines what integration is, examines policies to enable it and gives examples of integration schemes in England. It also looks at the evidence on the challenges of achieving integration and assessing the effectiveness of approaches.

Acknowledgments

POSTnotes are based on literature reviews and interviews with a range of stakeholders and are externally peer reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

Michele Abendstern – University of Manchester
Hugh Alderwick – The King’s Fund
Martin Bardsley – The Nuffield Trust
David Buck – The King’s Fund
Ricardo Codinhoto – University of Bath
Emily Crawford – ResPublica
Department of Communities and Local Government
Department of Health
Tom Gentry – Age UK
HM Treasury
Holly Higgs – British Medical Association
Local Government Association
Anne Mason – Centre for Health Economics, University of York
NHS Improvement
Nicholas Mays – Centre for Evaluation, London School of Hygiene and Tropical Medicine
Robin Miller – Health Services Management Centre, University of Birmingham
NHS England
Ellen Nolte – London School of Hygiene and Tropical Medicine
Kathleen Robson – Scottish Parliament
Anthony Sheehan – Church Health Center, Memphis
Peter Smith – Centre for Health Policy, Imperial College London
Andrew Street – Centre for Health Economics, University of York
Karen Taylor – Deloitte
Janice Thompson – Northern Irish Assembly
Mark Wilberforce – University of Manchester
Gerald Wistow – London School of Economics
Paul Worthington – Welsh Assembly Research Service