Progress in Building Integration: Lessons from Great Britain, Northern Ireland and the Basque Country

摘要

The integration of health and social care has been a constant policy goal of successive UK governments for over 40 years and is a contemporary priority now supported in Great Britain by legislation. It has been noted that the ‘imperative to integrate and transform has never been greater’ (NHS Confederation/Local Government Association, 2016). The main rationales for the importance of integration have also been largely accepted relating to; a holistic approach; facilitating a more person centred approach; producing a better experience and outcomes for users; reducing the complexity of organisational divisions, responding to more complex conditions and delivering more effective and efficient use of resources. Integration is also accepted as an appropriate response to increasing demands on both health and social care services. The challenges to transforming delivery are a consequence of well-established factors. Demographic change, with larger numbers of older people, changes in life expectancy, the needs of people with multiple health problems and complex conditions and large increases in the numbers of older people without a child to care for them if needed. The importance of integration has also been enhanced by the broader direction of change relating to health provision and the desirability of making a shift from acute hospital provision and institutional care to more community based provision covering community health services and social care. Integration is thus part of the envisaged transformation in care in health related areas. Other challenges have come from the impact of economic recession and austerity policy with reductions in the funding resources and increasing costs of services. The task of producing effective integrated care involves in Great Britain bringing together two separate institutional configurations, the NHS and local authority social services and also developing the delivery of integrated services and integrated practice. Numerous policy and delivery initiatives have been developed but generally progress has been piecemeal and limited. The Commission on the Future of Social Care (2014) noted the compelling case for bringing health and social care together, enabling better alignment of the two systems and leading to transformational change. In 2015 much closer integration of health and social care was identified as one of the three major challenges faced by the NHS (Ham, 2015). The Nuffield Trust (2015) has identified five factors to pursue in improving UK health care, each of which relates to integrated approaches, the NHS and social care reform; the quality of care; the workforce; new models of care delivery and older people and complex care. The existing, research on integrated care concludes that there is no one size fits all for achieving this ambition for integration, although factors such as leadership, financial incentives, clinical pathways and aligned IT systems have emerged as significant factors. This paper draws on the authors’ experiences of health and social care in Northern Ireland and the Basque country to suggest the key factors that drive transformation in healthcare systems and ensure that they achieve their full potential.