Integrating Care is sometimes used to refer to attempts to join up the parallel systems of health care that have existed since the NHS was created. For example, some patients can't be discharged from hospital because there is a lack of social care provision. But social care is the responsibility of local authorities and was never the responsibility of the NHS. So there are two parallel systems (see National Health Service Act 1946 ) of health care that need to be integrated.
From the late 1980s when the internal market was introduced and various aspects of the health service including long-term care were taken out of the NHS, our health services have become increasingly fragmented.
Integrated Care as a term, has been seized upon by those seeking to expand the role of the private sector. In this context it is redefined (like other bastardised terms such as Patient Choice ) to justify the radical redesign of health services. The cynical use of the term puts less emphasis on patients' needs and focuses more on integrating organisations and introducing new ways of working, payment systems, and so on, that will keep health care systems under tight central control and ensure that they will cut costs in response to government underfunding.
As NHS health care is free at the point of use, and other care such as long-term care, residential care and social care is funded by means-tested user-charges, integrating health and social care while keeping the market system will require steps towards restricting services and introducing means-testing and user-charges for services that are currently free at the point of use. In other words,
Integrated Care is about the management of long-term conditions through alternative systems and pathways to traditional methods (I.e. hospitals and the GP doctor-patient relationship). The alternative pathways include: rationing services, keeping hospital care to a minimum, encouraging
self-care, and introducing new ways of paying for services.
In 2006, the NHS National Leadership Network produced a document stating that
Integrated Care is not just about the shift of hospital care towards the community, but the reconfiguration of NHS infrastructure. This means a radical reduction in the number of NHS hospitals and the development of new facilities to house 'integrated care services'
decoupled from the NHS, and dovetailing with the expansion of the private sector.
England already has one of the lowest numbers of hospitals per head of population, coming below Poland, Czech Republic, Estonia, Mexico and Korea. Transferring care into a community setting (often into the responsibility of local authorities and GPs) can not in any case work without increased allocation of resources to those bodies. In fact the opposite has been happening (see Prevention ).
There is no evidence that
Integrated Care is any cheaper than providing hospital care. Health economist, Professor Maynard has cited many integrated care evaluations, including by the Department of Health, which demonstrate no savings.
The 'transformation' that the NHS in England is currently undergoing in the name of
integration is actually solidifying fragmentation. It's making local areas appear responsible for poorer services as a result of the underfunding from central government and - because of the variation in health need and resources between these areas - it will lead to further health inequalities and regional differences in health provision.
Also see Big Picture - Post 2012 NHS Plans