Inclusive integration: How whole person care can work for adults with disabilities

The concept of 'whole person care' is about making the connections between physical health, mental health and social care services, focussed on the needs of an individual. The drive to develop a health service that is fit for the future is firmly grounded in the need to plan for an ageing population. There is a danger, however, that with so much of the focus on the needs of older people, there is insufficient attention given to the distinct needs of other groups of health and care service users.

Not only do they have different needs and outcomes to older people, but working-age disabled adults also face more severe and widening health inequalities across all areas of day-to-day life, for example in housing, employment, financial security and quality of life. To be effective, service integration must go further than health and social care alone, and focus on local patient demographics and the unique needs of service users.

This report provides an empirical evidence base to demonstrate how whole person care should meet the needs of working age disabled adults. There are real challenges to integrating a health system that is free at the point of delivery with a means-tested social care system. There are also risks to the independence of disabled people if a more 'medical' model of the NHS was allowed to predominate over a whole person care approach.

In response to these challenges, we make seven key recommendations to inform service reform:

1. A long-term view should be taken to managing long-term conditions, and so we recommend that whole person care should be conceived as a 10-year journey, matched by stable funding over this period.
2. The continuing debate about how to manage the funding gap in social care must take into consideration the needs of working-age disabled adults.
3. Prevention must remain high on the agenda when planning services over the long term.
4. Supporting prevention would be strengthened by shifting resources from case management to community coordinated care.
5. Service integration should take place across a much wider range of services, beyond health and social care, supported by care coordinators rooted in communities.
6. Health and wellbeing boards should lead local authorities and clinical commissioning groups in prioritising public engagement across all service user groups.
7. Government should invest in local advocacy projects to support public engagement.