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Health and Social Care Integration (England)

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 current 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 has committed £3.9 billion in 2016/17. There have also been a number of smaller, pilot projects to improve integration.

Many of these policies are relatively new, and so detailed evaluation of performance is often limited in its availability. However, their impact so far, and comment from those in the health and social care sectors is examined. In the case of the Better Care Fund, the policy has not yet succeeded in reducing the number of emergency hospital admissions and delayed discharges, which have continued to rise in recent years.

Also examined is the relationship between recent policies to promote integration and broader NHS reforms, as set out in NHS England’s Five Year Forward View strategy and to be implemented through local Sustainability and Transformation Plans. This briefing also looks at the devolution of health and social care powers to some local areas in England, particularly Greater Manchester.