Health and Social Care Integration

Health and adult social care services in England have traditionally been funded, administered and accessed separately. Health has been provided free at the point of use through the National Health Service, whilst local authorities have provided means-tested social care to their local populations.

As a result of demographic trends, including an ageing population, an increasing number of people require support from both health and social care services. It is argued that these patients can be badly served by the traditional health and social care model, and that by integrating the two services, the patient can be put at the centre of how care is organised.

As well as improving the experience for the patient, it is argued that integration can save money by cutting down on emergency hospital admissions and delayed discharges. This is particularly significant in light of current funding pressures for the NHS and local authorities, although the scope of potential savings has been disputed.

Successive Governments have sought to better integrate health and social care by focusing on care outside of hospital, instead delivering care as close to the patient as possible, either at home or in their community.

This briefing looks at the challenges presented by the integration of health and social care, as well as recent Government policies to promote integration. These have included the creation of Health and Wellbeing Boards, local strategic planning forums with representatives from health and social care services, and the Better Care Fund, a pooled budget between the NHS and local authorities, to which the Government committed £7.8 billion in 2018/19. In 2019, the Government and NHS England announced a review of the Better Care Fund, which will look at concerns including the complexity of its funding mechanism and actual returns on investment.

Integration is a central goal of the NHS, as set out in NHS England’s Five Year Forward View  (October 2014) and the subsequent NHS Long Term Plan (January 2019). The Long Term Plan emphasises new models of integrated health and social care delivered via Integrated Care Systems (ICSs), which will develop from the current Sustainability and Transformation Plans (STPs). There are currently 14 ICS areas in England, and the intention is that ICSs will be in place throughout the country by April 2021.

In September 2019, the NHS set out legislative proposals for a new draft Bill, to implement the NHS Long Term Plan and enable different parts of the NHS to work together, and with partners, more easily. The Bill would replace the current NHS procurement framework, which is seen by commissioners and providers as a barrier to integrating care at scale. The Bill would also repeal current barriers to creating new NHS Trusts, with the intention that new NHS Trusts could be developed in the future to integrate services at scale and hold new Integrated Provider Contracts (ICPs). Proposals for an NHS Bill were included in the Queen’s Speech October 2019.

As health and social care are both devolved policy areas, this briefing focuses largely on integration in England. However, the four UK nations have taken different policy paths with regards to integration. Scotland and Wales have both passed recent legislation promoting integration, including moves towards fully integrated health and social care commissioning in Scotland, whilst Northern Ireland has had an integrated health and social care system since the 1970s. The policy landscape in Scotland, Wales and Northern Ireland is explored towards the end of this briefing.