Across the four counties of the UK, integration of health and social care has been a policy priority driven by the needs of a population that is living longer and with more long-term health conditions.
The aims of integrated policy reform have largely been consistent: to improve patient and service user experience, quality and efficiency by reducing fragmentation within and across services, and to improve population health and wellbeing.
The different paths taken from across the UK to achieve these central aims allows us to draw insight and learning on how integration can work most effectively, and how different approaches to implementation or emphasis within policy may have contributed to different outcomes for communities.
However, the extent to which integration has been achieved in these countries – and what benefits, if any, that has had for patients – is open for debate.
In this report, we identify and review ten measures to examine the evidence for the impact of integration across the four UK countries, and compare policies and approaches each country has trialled to deliver their goals.
- Despite longstanding goals in each of the UK's four countries to integrate health and social care services, there is limited evidence that policies in any of these countries have made a difference to patients, or to how well services are integrated.
- Across countries, there has been a persistent mismatch between some of the stated objectives of integration, and what better collaboration between health and social care can meaningfully achieve.
- The data to measure integration effectively are limited, and variable targets have been used. However, across England, Scotland and Wales, we found that:
- Satisfaction with care and support has been stable or falling,
- Improvements in delayed transfers of care have not been sustained and
- The age-adjusted rate of emergency admissions to hospital has not fallen.
- Over 20 years of reforms have translated into only modest improvements for patients across each country, which raises important questions about what integrated care can realistically achieve.
- There is limited evidence from any country that pooled budgets and other forms of integrated finances have increased cost savings or productivity. This implies that delivering savings should not be adopted as an immediate core outcome or objective for integration.
- Successive governments have tried to establish integrated partnerships without due regard for existing relationships and structures already in place or for how long changes take to come into effect.
- Having a legal duty to collaborate does not in of itself lead to effective collaboration, which also relies on having sufficient resources, incentives, regulatory and outcomes frameworks – and consistent leadership and cultures across health and social care.
- Realistic goals, and data to measure them, will be important to monitor the success of the latest reorganisation of the NHS and social care in England and Scotland.
- Without significant changes to the broader government policy and the distribution of resources, the latest reforms are likely to yield similar results.
You can also watch the Summit Series session where the authors discussed this report below.
Reed S, Oung C, Davies J, Dayan M and Scobie S (2021) Integrating health and social care: A comparison of policy and progress across the four countries of the UK Research report, Nuffield Trust