The importance of different parts of the health and care system working together in the best interests of the public and patients, regardless of legislative barriers, has been known for many years. Collaboration between health and social care has been accelerated significantly over the last 2 years, demonstrating what can been done when working together, being flexible, adopting new technology directed towards the needs of the patient and putting aside red tape that has stifled creativity and innovation.
The purpose of integrated care is to enhance people's care outcomes and their experiences of care provision, by bringing services together that are located around people and communities. Achieving this will require tackling the fragmentation of services and the lack of co-ordination that people can experience, by providing person-centred care that is joined-up, responsive and appropriate.
The ongoing absence of a unified approach to health and care continues to result in a disgraceful waste of scarce public resources, particularly the enduring issue of delayed transfers of people and their care from NHS hospitals, free at the point of need, into means-tested care provision within the community. The integration of the two systems has real potential to lead to a far more humane approach to addressing people's needs and to the gradual alignment of staff terms and conditions – this would be particularly beneficial for care staff. The question has to be asked: why has integrated care not become the reality that it could have become, when it is what patients and staff can see is needed?
The Health and Care Act 2022 has received Royal Assent. This now enables the establishment of integrated care systems, moving them on to a statutory footing with the establishment of integrated care boards and integrated care partnerships. The establishment of integrated care boards and integrated care partnerships will occur at the same time as abolishing clinical commissioning groups (CCGs). The integrated care boards will adopt the NHS commissioning functions of CCGs and some of NHS England's commissioning functions. They will also be accountable for NHS spend and performance within the system. Integrated care systems are partnerships bringing together NHS organisations, local authorities and others, taking collective responsibility for the planning of services, improving health as well as reducing inequalities across geographical areas.
Integrated care services are key to the reforms introduced as part of the Health and Care Act 2022 and are part of a shift in how the English health and care system is organised (Charles, 2022). After decades where the emphasis was on organisational autonomy, unhealthy competitive drive and the split between commissioners and providers, integrated care services rely instead on collaboration and a focus on local populations driving improvement for those who use services.
The integration of care services can make a significant difference to the population but it is imperative that this is done in the appropriate way. What needs to be established is how such systems and the partners working in them will know if they are meeting the needs of the people they serve. Those who are best placed to understand what they need, what is working and what might be improved must be those people and communities who are using services. Their lived experience is a powerful tool to improve existing services and to identify better ways to meet the needs of people.
A key challenge is to address the fundamental issue of funding when attempting to integrate the work of two organisations where one is means-tested and the other free. A long-term political aspiration, for any administration, should be the provision of universal free social care, alongside free NHS care. It is acknowledged that the management of our health and care service is complex and it will cost money to integrate, but it must also be accepted that such an approach will end the significant ineptitudes that plague the two separate structures.