It is desirable because it promises to improve the quality of care for those who rely on multiple services and reduce health system costs at the same time. More recently, aspirations for integration have expanded to encompass reducing health inequalities and making a tangible impact on local economic development.
However, this has proven difficult in practice. Past attempts to encourage integration, such as the Better Care Fund and the Integrated Care Pioneers Programmes, have not improved patient outcomes or reduced costs. Now the government is moving ahead with new proposals to reorganise the health service. This comes at a time when pandemic continues to create uncertainty and when one in 10 people in England are waiting for treatment they need.
The reforms proposed by the government in the health and care bill have an opportunity to break with the past. The bill as it stands might put in place useful structures, but this alone will not be enough. Getting integration to deliver improvement depends at least as much, if not more, on culture as it does on structure. A culture of collaboration cannot simply be bottled and shipped – but it can be shaped. As such, this paper explores how the government and NHS England can take their reform agenda one crucial step further and looks to inform the forthcoming white paper on integration.
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