The holy grail of health and social care integration

According to a recent report by the National Audit Office (NAO),1 “nearly 20 years of initiatives to join up health and social care . . . has not led to system-wide integrated services” and “there is no compelling evidence to show that integration leads to sustainable financial savings or reduced hospital activity.”

The only strictly incorrect element in the NAO’s critique is the timeline: we have been trying to integrate care for much longer, going back at least as far as the joint care planning, joint finance, and joint consultative committees of the 1970s. We also saw joint hospital discharge protocols in the 1990s, the growth of multidisciplinary mental health and learning disability teams, national guidance on joint commissioning, pooled budgets, a single assessment for older people, the creation of care trusts (integrated health and social care organisations), and the advent of joint strategic needs assessments—not to mention Labour’s integrated care organisation pilots; the Coalition government’s Better Care Fund, integrated care pioneers, …