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Integrated care in Northern Ireland, Scotland and Wales: Lessons for England

The aim of this report is to describe the approach taken to integrated care in Northern Ireland, Scotland and Wales with a view to drawing out the lessons for England. The report has been written at a time when policy-makers in England have made a commitment to bring about closer integration of care both within the NHS and between health and social care. This creates an opportunity to understand what has been done in the other countries of the United Kingdom to develop integrated care in order to inform policy and practice in England.

With this in mind, we commissioned authors in each of these countries to write a paper covering the following issues:

  • the context in which health and social care is provided including the governance and planning of these services and organisational arrangements
  • policy initiatives to promote integrated care pursued by the devolved governments, and the impact of these initiatives
  • the barriers and challenges to achieving integrated care, and how these have been tackled and overcome.

We also invited the authors to reflect on what England could learn, drawing on their own experience and assessment of what has and has not been achieved in the country that they were asked to write about.

Early drafts of the papers were discussed at a seminar with the authors and this provided an opportunity to identify similarities and differences and emerging themes. Further drafts followed and these were then reviewed by experts in integrated care both within The King’s Fund and outside. The papers published here have incorporated comments on these drafts, and provide comprehensive and up-to-date descriptions of the experience of Northern Ireland, Scotland and Wales and the lessons that can be drawn from this experience.

While the papers follow a broadly similar format, based on the brief given to the authors, there is some variation in the issues covered and the analysis offered by the authors. This reflects differences in the data sources that were drawn on in preparing the papers and in the availability of evidence in each country. The final section of this report offers an overview of the three countries and has been written to compare and contrast their experience and explicitly to identify lessons for policy-makers and practitioners in England.

This report was written in parallel with an analysis of health policy in the four countries of the UK written by my colleague, Nick Timmins. As Nick emphasises, there is enormous potential for countries to learn from each other but in practice this rarely happens. The natural experiments that have emerged since devolution have accentuated pre-existing variations between countries but policy-makers have shown little interest in studying these variations and learning from them. This report is a modest attempt to encourage greater curiosity and lesson learning in the hope that others may see its value and follow our example.