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Stepping up to the place: The key to successful health and care integration

Bringing together health and social care has been a constant and dominant policy theme for many decades, and many places around the country are already demonstrating the potential to do things differently.

We – the Association of Directors of Adult Social Services, Local Government Association, NHS Clinical Commissioners and NHS Confederation – believe, however, it is time to change gear. The status quo is no longer an option, and everyone must innovate and transform on a scale and at a pace not yet seen.

The imperative to integrate and transform has never been greater – from finding ways to organise services around the demands of a population with more complex and chronic health and social needs, to responding to the extremely challenging financial context for the NHS and local government. Integration is not an answer in itself, or a panacea for the system’s financial challenges. Its primary purpose is to shift the focus of health and care services to improving public health and meeting the holistic needs of individuals, of drawing together all services across a ‘place’ for greatest benefit, and of investing in services which maximise wellbeing throughout life.

We believe it is time to put integrated systems and services to the test, to translate aspirations into action, and to ensure they deliver for our citizens. So we have come together to describe what a fully integrated, transformed system should look like based on what the evidence tells us. This builds on our existing joint work over many years, and takes it to the next level – to call on local and national stakeholders to work together to ensure integration becomes integral to a transformed system. In short, to enable integration to be seen as business as usual.

To make this happen, we call on everyone to join us in testing and developing the principles and practices set out in this vision, to learn and to share, to challenge and to deliver. This will involve pushing ourselves and our partners to deliver the best outcomes for our communities. It will mean understanding the big issues that need to be addressed – at a local and national level – to make integration not only happen but to make sure it improves the health and wellbeing of our populations. This includes acknowledgement and redress from national leaders that the unprecedented pressure on funding remains one of the greatest risks to success.

It will mean being clear why partners stand together, stepping outside institutional siloes and navigating multiple meanings of ‘place’. It means redesigning the health and social care landscape together, decommissioning services as well as creating new ones, sharing risks and jointly being responsible for what may be difficult decisions within a complex, challenging and changing system. To really make a difference, it will be a demanding task at times, but is one we must, and can, achieve together.