Shaping the future of integrated care: what can we learn from history?

Introduction

Published literature on integrated care usefully brings together wide-ranging definitions and concepts (e.g., breadth, function) but pays little attention to the historical record (e.g., political priorities, policy agendas, and social pressures). Historical analysis highlights how these factors have shaped the integrated care agenda over time.

Aim

To draw out lessons for future policy by considering UK policy developments around ‘integration’ since 1948.

Methods

Literature-based review, combining historical evidence (1910 onwards) from UK published and grey literature. Analysis of integration of health and social care, and the integration of primary and secondary care.

Results and conclusions

Historical analysis reveals that policymakers have often shared a desire to improve the quality and efficiency of services by coordinating policies, processes, organisations, services and actors. Key ‘drivers’ of integration have been changing professional and public perceptions of the remit of the health services, which organisations have a part to play in safeguarding the public’s health, and how we conceptualise the boundaries of healthcare. However, history also teaches us how easily reforms currently envisaged as furthering the cause of integration can, in the long run, further cement existing gaps in service provision.