To read on The Guardian website:
Integration is not a cure-all for health and care – look at Northern Ireland
In 1965 the Seebohm committee was appointed to consider how best to shape social welfare. In the same year I qualified as a social worker. In the half-century since, there have been numerous attempts to secure better integration of services. Now the belated realisation that the scale of cuts in adult social care has contributed greatly to the pressures on the NHS has again directed attention to the boundaries between health and social care.
In this discussion there has been little examination of Northern Ireland, with its 45 years experience of an integrated system. There, integration has failed to address a reliance on hospitals and institutional care which is significantly greater than elsewhere in the UK. A model based on community-based services remains an aspiration.
Why has change proved so difficult to achieve? And what are the lessons for integration elsewhere in the UK?
I saw some of the difficulties in promoting a model of community-based care while working in Northern Ireland in the 1980s as director of social services. First, short of closing down buildings, it is difficult to get resources out of acute care. Even if you do, the patient population in hospitals will have a greater degree of need and complexity, demanding higher staffing ratios.