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This blog post was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

The journey towards integration – how much further to go?

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There’s a joke going around the policy circuit that, at the end of time there will only be two things left: cockroaches and a couple of people trying to work out how to integrate health and social care.

A cynical view perhaps, but we only have to look at the history of policy making to see why. It was back in 1974 when there was the first attempt at statutory duty on local authorities and health to work together There have also been numerous attempts since then to integrate health and social care: strategic partnerships, the Darzi review, and the Care Programme Approach to name a few.

Fast forward to the current day and the integration of health and social care is high up the political and policy agenda once again. The Minister for Health and Social Care, Norman Lamb MP has said that ‘the health service must adapt in innovative ways to accommodate evolving, and increasingly complex, patient needs’. Norman Lamb also announced in May ‘a new Pioneer Sites Programme which will provide support for ten sites across the country working to explore how they can integrate their services’.

Meanwhile an independent commission has been created by the Labour Party to make recommendations for delivering ‘whole person care’ and will be reporting to the Shadow Cabinet in due course.

Last month, the Mental Health Foundation launched our report on integrated care: Crossing Boundaries, which was the result of an inquiry and a call for evidence which received over 1200 responses. We found a pressing need for more inter-professional education and training on mental health, especially given the close relationship between physical health problems and mental health. We know that poor physical health can lead to mental health problems, just as we know that people with mental distress are more likely to develop physical health problems.

The inquiry also found that an ‘underpinning essential’ for integrated care was leadership to drive forward integration at a strategic level.  It is perhaps concerning then to learn this week that the only NHS trust known to have a post with a social care leader at board level across England's NHS mental health services has been removed. Leadership from social care as well as health care is fundamental to addressing the inequity in mental health provision, as well as moving forward on a truly integrated system of care and support.


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  1. Comment by Gillian Dalley posted on

    There are structural and professional barriers that need to be overcome apart from the 'practical' ones sometimes attempted (such as shared or pooled local budgets, co-location, joint training, goodwill, 'bang their heads together' messages from government). If the budget streams remain structurally separate right up to Treasury level, integration will never be possible - each side of the divide will, especially in times of austerity and when the chips are down, fight to protect its own resources. The other barrier - professional interests - are also difficult to address. Interprofessional education doesn't always work (check the research) and professional perspectives and attitudes, differences in knowledge base, status, salaries, organisational culture and 'sticking together when times get tough' tendencies all work against the goal of integration. For these reasons, pilot after pilot will never really get to the root of things. Sadly, until all the fissiparous factors are acknowledged and tackled, 'twill be ever thus.

  2. Comment by K Morgan posted on

    Less group hugs and more talking outside individuals mini kingdoms may actually allow any decision makers to make a decision. Until vested interests are removed and defensive barriers are brought down there never will be unity. After 39 years even the most indecisive should have made some kind of decision, but if you are to make a genuine attempt at common sense you do not need a committee you need a real decision maker with no department to support, just the sick. You then have to get the decisions past the committee that would inevitably be formed to look at the decision makers decision. Now we are talking, real progress at last.
    Hears to another 39 years and counting.

  3. Comment by A Cavanagh posted on

    Very true all for one and one for all ?

  4. Comment by Nick posted on

    It would be quite a good start if the health system itself was integrated instead we have CCGs distrustful of each other (and often too small to influence events), over powerful foundation trusts whose business model creates disincentives to community based solutions and an overarching financial structure that disincentivises integration. On the other side you have Local Authorities facing an almost impossible financial future. If it couldn't be done when we had PCTs and reasonably funded LAs it's hard to see it succeeding now. I think the only way we are really likely to achieve change is by a significant realignment of resources and a shift of health commissioning to Local Authorities

  5. Comment by shurleea posted on

    No health without mental health ... sounds good but go to a general hospital with a broken leg and they will attribute that to your mental health! Let the general sector know you have a mental health history and they treat you as if you are a nuisance wasting their time.

    The general sector cannot see beyond mental health, they think you are likely to explode in front of other patients, or become very disturbed.
    So many mental health patients hold down very responsible jobs, the are very well educated and manage their illness very well, but trying telling a hospital consultant that?

    Often physical health problems are missed because of the stigma around mental health, some doctors can't even be bothered to give folk the time of day, so it is a very real fact, that mental health patients keep their illness to themselves, and as in-pteints, may miss out on vital medication to hide their backgrounds.

    The NHS really needs to work hard to earn the trust of mental health patients, hence so much concern about sharing medical records!

  6. Comment by Helen Rowe posted on

    So who can make it happen because all the while the rhetoric is going on the service users/patients are getting a very poor deal, today's news headlines re loss of support for mental health users of services and this actually creating a bigger burden financially is just more evidence that integration is needed.

  7. Comment by Emily posted on

    Thanks everyone for your comments – really interesting points about separate structures and separate budget streams; and the implications for integrated care. I agree that the budget streams must be integrated too in order for true integration to become a reality!