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Benefits of integrating health and social care ‘over-estimated’, Nuffield Trust suggests


By Jess Hacker
14 December 2021

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The benefits of integration of health and social care services across UK countries ‘continues to be over-estimated’, the Nuffield Trust has claimed.

Published today (14 December), the Trust said in its new report the ‘despite long-standing goals’ there is ‘limited evidence’ that policies to integrate both kinds of services ‘have made a difference to patients’.

It said that the culmination of more than 20 years of reforms have translated into ‘only modest improvements for patients’ across each country.

The approach to integration has focussed too heavily on structural rather than cultural change, it suggested.

It added that this raises ‘important questions’ about what integrated care ‘can realistically achieve’.

It comes after the Health and Care Bill – which is set to further embed integrated care by granting statutory footing to Integrated Care Systems (ICSs) – progressed onto the committee stage in the House of Lords.

Structural reform ‘insufficient’

Improved collaboration comes down to ‘relationships and partnership working’, the authors argued, suggesting it is ‘unlikely’ to come about via structural change.

They stated that a reliance on structural and organisational changes to deliver integrated health and social care at a patient level has ‘failed’ to address long-standing barriers to integration.

In each UK country, integration has been challenged by systemic factors, including:

  • A lack of resources, infrastructure and staff
  • Diverging cultures and priorities across health and social care
  • ‘Insufficient’ regulatory and outcomes frameworks to help understand system performance
  • Broader economic and political contexts, such as a ‘mismatch in the funding’ available across health and social care.

None of these can be easily resolved through organisational changes alone, they said.

‘The ability of health and social care partnerships to collaborate effectively has depended more on the scale of their ambition and the maturity of their partnerships than their design and structure, with policy consistently emphasising the latter, sometimes at the expense of the former,’ the report stated.

The authors surmised that ‘legislation alone will likely be insufficient to drive cultural changes’.

ICSs alone ‘will not be enough’

Current approach to foster integrated care, such as the introduction of ICSs in England, will ‘not be enough’ to overcome the complex barriers and create appropriate cultural change, they stated.

‘Real progress’ will require shifting the focus away from organisational reform, they said.

Failing to do so risks reorganising services at ‘significant’ cost and disruption without addressing the ‘behaviours, incentives, skills and resources’ needed to integrate services ‘at the front line’.

Last month, NHS England announced a GP ICS lead would be reviewing the ‘next steps’ for how PCNs will work in ICSs.

Speaking at the November NHS Confederation ICS conference earlier, health secretary Sajid Javid maintained that ICSs are ‘the right way forward’.

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