Health and social care integration – is there really a choice?

The financial imperatives facing public services support a growing consensus that integration of health and social care is financially inevitable, as well as the right thing to do from a quality perspective.

‘Integration may require an early leap of faith, supporting frontline staff who ask “why not” instead of “why”’

Over the past 20 years, more than 300 health and social care organisations have worked with Capita’s health advisory business. This work has suggested that there are four fundamental lessons for successful integration.

• We must be bold. Integration may require an early leap of faith, supporting frontline staff who ask “why not” instead of “why”. Change brings risk but risk can be managed. Where risks do materialise, strong leadership is required to embrace the lessons learned and maintain the vision, recognising that the journey to integration needs to be flexible and take account of particular, local, circumstances.
• We must be honest and acknowledge the reality that although hearts and minds accept the case for integration, some people may not yet have the stomach for it. Local authorities and NHS organisations may still have tribal perspectives on the case for change, borne from cultural, structural and accountability differences. Varying experiences of the way financial pressures are felt can fundamentally limit progress. Organisations engaged in integration need to ensure they can demonstrate tribal “wins” to their respective councils, boards or governing bodies.
• The journey to integration involves real transformation and can’t be done as an add-on. Health economies that are most likely to make progress are those that actively invest in leadership development; dedicated, empowered and accountable joint delivery structures; and in the sort of creative thinking that allows workforce and financial resources to flow to the most appropriate places.
• Partnerships must develop and maintain shared accountability mechanisms that bite. Where expected quality and financial outcomes are not realised local partnerships need an effective shared performance management framework across organisations, services and for individuals, backed by the freedom to develop the right incentives and drive the right behaviours.

‘We need to share the benefits and the risks, set performance goals and develop a shared culture’

We need to share the benefits and the risks, set performance goals and develop a shared culture with the self-awareness to know when, where and how things need to improve.

The drive for integration may currently be about organisational change and/or improved use of resources but delivering integrated care is ultimately about how professionals and citizens share responsibility for achieving outcomes and requires both new thinking and new ways of operating by all involved.

In our experience, the organisations and partnerships that truly understand this are the ones that move beyond documents and working groups to deliver real and sustained financial and quality outcomes. 

Niall Thomson is director and market lead within Capita’s health advisory business and Tim Gardener is managing consultant and operational improvement capability lead