I don't know how many times I have heard that integrating health and social care does not require structural change - bringing together the provision or commissioning of both under one organisation - and that it is really about culture, shared outcomes and goals and good leadership.
Well for a different perspective, read this blog from consultancy iMPOWER, which has been working with Herefordshire Council and the local NHS to establish Wye Valley NHS Trust, the country's first integrated provider of acute and community health services and adult social care. As we have reported before, Herefordshire has a long history of organisational integration with a joint management team for the council and the primary care trust.
The iMPOWER blog post argues that partnership arrangements - of which health and well-being boards are the latest example in England - depend on strong personal relationships to succeed. Where these are lacking, they struggle, and financial problems for both councils and the NHS are bringing increasing tensions to these relationships.
Bringing health and social care together more formally to underpin the health and well-being boards can help to overcome this reliance on strong personal relationships," it argues. "In our experience doing so can make those involved think very differently, and better decisions can be made as a result."
iMPOWER says that in Herefordshire, council reablement and NHS intermediate care services have come together - a sensible move given that they perform a pretty similar role and have similar objectives - and social workers and NHS colleagues have gained a better understanding of what they each bring to services.
However, it warns that such integration only happens very rarely and when there is a strong imperative to do so, as there is too much to lose for both sides. That is why it would be a good idea to take a decision to integrate - organisationally - nationally - though leave the detail of implementation up to local areas, as has now happened in Scotland.
It suggests that this move could change the terms of debate in England in the direction of nationally ordained (though not micro-managed) integration.
Well for a different perspective, read this blog from consultancy iMPOWER, which has been working with Herefordshire Council and the local NHS to establish Wye Valley NHS Trust, the country's first integrated provider of acute and community health services and adult social care. As we have reported before, Herefordshire has a long history of organisational integration with a joint management team for the council and the primary care trust.
The iMPOWER blog post argues that partnership arrangements - of which health and well-being boards are the latest example in England - depend on strong personal relationships to succeed. Where these are lacking, they struggle, and financial problems for both councils and the NHS are bringing increasing tensions to these relationships.
Bringing health and social care together more formally to underpin the health and well-being boards can help to overcome this reliance on strong personal relationships," it argues. "In our experience doing so can make those involved think very differently, and better decisions can be made as a result."
iMPOWER says that in Herefordshire, council reablement and NHS intermediate care services have come together - a sensible move given that they perform a pretty similar role and have similar objectives - and social workers and NHS colleagues have gained a better understanding of what they each bring to services.
However, it warns that such integration only happens very rarely and when there is a strong imperative to do so, as there is too much to lose for both sides. That is why it would be a good idea to take a decision to integrate - organisationally - nationally - though leave the detail of implementation up to local areas, as has now happened in Scotland.
It suggests that this move could change the terms of debate in England in the direction of nationally ordained (though not micro-managed) integration.
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