To integrate, or not to integrate…? by Viv Sugar

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

It’s discussed endlessly, but we seem no nearer a consensus: should health and social care be formally integrated? This is the subject of Viv Sugar’s blog this week in our ‘20 blogs for 20 years series’, to mark the Institute’s 20th anniversary. Viv has a wealth of experience at the most senior levels in local government and across the public sector more generally, in Wales and throughout the UK. Different approaches to integration proliferate, and there’s much to learn from them all… but which is best?

To integrate, or not to integrate…?

In 1974 I was working in Teesside County Borough Council’s Health Department when our service was transferred into the NHS. With a highly regarded, innovative and creative service pioneered by the Medical officer of Health, Dr Paddy Donaldson and a progressive Minister of Health in Barbara Castle, I was optimistic about the future. But 6 months in, I had no definitive budget to work to, orders of sterile supplies were not arriving in time for our clinics and with complaints falling on deaf ears, I realized that the total focus of the new Senior Management was on the hospitals and not the community.

Why am I remembering that now? Because two recent experiences have shown me that forty years on, acute, community and social care services are still not as seamless as they need to be to ensure the best outcomes for patients and carers. Of course individual personal experience does not necessarily make a solid foundation for the development of public policy but recent experience of frail elderly relatives who live alone and a visit to Scotland have made me realize how much more we need to do. Liaison between hospital, GP, District Nurses and Social Services required some family intervention to make it work. Individually most of the staff, the doctors, nurses and carers were professional, compassionate and trying to do their best under great pressure and with limited resources. But there was a lack of clarity about who was “championing” the patient and finding a path through the maze of agencies, voluntary bodies and the complexity of the DWP and Council forms that had to be completed. At the most basic level who could be found to boil an egg when appetite was not up to coping with a Meal at Home offering?

A few weeks ago I visited one of the Scottish Councils who have formed a Health and Social Care Partnership with their local NHS Region. The Partnership Director reports to both the Council and the NHS Chief Executives and sits on their Management teams. In that area, clinical health professionals, social work services, housing services, care home and home care providers, voluntary and community services and representatives of people who use health and social care services are all working together as partners for change. The Partnership brings together local government services for children, families, adults and older people with Community Hospitals, District Nursing, Community Mental health services, Learning Disability services, allied health professionals etc. Their vision is of enabling everyone to live longer, healthier lives at home or in a homely setting. The focus is on prevention, anticipation and supported self- management. For older people they aim to deliver more care at home by increasing the number of integrated community teams in local communities around G.P. practices. Sharing information and increasing access through a single point of contact and sustaining independent living.

I was impressed but they stressed that they are only 6months in. And then they asked me what they could learn from Wales…..

Viv Sugar


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