The International Journal of Integrated Care, has recently published an article by Professor Jon Glasby, entitled 'If Integration is the answer, what was the question? What next for English Health and Social Care?
Glasby, J 2016 If Integration Is the Answer, What Was the Question? What next for English Health and Social Care Partnerships? International Journal of Integrated Care, 16(4): 11, pp. 1–3, DOI: http://dx.doi.org/10.5334/ijic.2535
‘Integrated care’ has been a key policy priority in English health and social care in recent years – although the extent to which this commitment is real rather than rhetorical remains open to debate. While everyone working in health and social care knows that single agency responses are insufficient when trying to support people with complex needs, there is a danger that ‘integrated care’ becomes a buzzword, apparently capable of resolving a range of different longstanding policy problems at once. This is particularly the case in a very challenging financial climate, when some policy makers appear to assume that this way of working will be able to dramatically improve outcomes whilst also significantly reducing costs.
Against this background, both research and recent practical experience suggest one thing that probably will not work, and four things that might. Often, debates about integrating care can focus on integrating separate organisations, and the English NHS in particular is reorganised on a regular basis. While such structural ‘solutions’ look dramatic and bold, the evidence around mergers and acquisitions (in both public and private sectors) is that they rarely achieve stated objectives, often fail to save money and tend to reduce morale, productivity and positive service developments (often for some 18 months to two years after the initial change – if it is managed well). Moreover, the evidence from the NHS is that hospital mergers tend not to take place for the reasons stated in the consultation document – but in response to local/national politics, to save money (even though they tend not to) and to get rid of management teams that are deemed to be failing. None of this is to say that changing structures cannot be part of a broader solution; it is just that it often isn’t – and it certainly should not be the first place to start.
This perspectives paper forms part of an IJIC Special Issue on the Building Blocks of Integrated Care. The paper was drawn from a presentation made during a series of six webinars, and a public lecture, organised by the International Foundation for Integrated Care and funded by Edgehill University.
Jon Glasby is Professor of Health and Social Care and Head of the School of Social Policy at the University of Birmingham. This commentary is based on a public lecture given as part of Edge Hill University’s ‘I4P’ lecture series in April 2016, in conjunction with the International Federation of Integrated Care. It draws on Glasby and Dickinson’s (2014) Partnership working in health and social care: what is integrated care and how can we deliver it (2nd ed.). Bristol, The Policy Press.