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Integrating community health and social care

Partner Institute: 
London School of Economics and Political Science
Survey no: 
Adam Oliver
Health Policy Issues: 
Pflege, Qualitätsverbesserung, Zugang, Patientenbelange
Screening for early detection
Reform formerly reported in: 
Developments in social care
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja nein ja nein nein nein nein
Featured in half-yearly report: G-politik in Industrieländern 7/8


In January 2006, the Government published a White Paper which outlines plans to improve and better integrate health and social care services. To help finance these changes, the Government intends to shift 5% of the resources currently spent on secondary care to primary care over the next ten years, and has emphasised that although 90% of patient contact with the NHS occurs in the community, the UK still spends less than the European average on primary care.

Purpose of health policy or idea

The better integration of health and social care is a major policy objective for the current Government (see the previous report in 6(2005)), hence the publication of the White Paper 'Your Health, Your Care, Your Say'.

The Government undertook a public consultation exercise in order to inform the content of the White Paper, and has announced that the public appear to want the following three things from community health and social care services:

  • they would like more control over their own health and care;
  • they would like better support to maintain their health, independence and wellbeing;
  • they would like rapid and convenient access to high quality, cost-effective care.

It would have been perhaps more instructive had the Government also asked the public how these obviously desirable demands would be financed, and whether they would be willing to pay more taxes to help realise these desires.

Main points

Main objectives

The broad objectives are to improve the integration between health and social care and to develop and improve access to community care in general, with a view seemingly to provide services that better suit regional (and even individual) 'needs'.

The Government's intention is to offer people more choice over GPs, to extend GP practice opening hours, to provide more support for people with long-term conditions, and to invest in new community hospitals and health centres (it plans to open 125 new health centres by the end of 2006, and is committed to building, rebuilding and/or refurbishing 50 community hospitals).

Type of incentives

The Government has announced a wide range of intended policies, that involve a mix of financial and non-financial incentives. The policies include:

  1. Shifting spending from hospitals to primary care;
  2. Giving local councils (who traditionally finance and plan social care) and the NHS new responsibilities to work together to provide 'joined-up' care plans;
  3. Shifting some specialities - dermatology, ENT, orthopaedics, gynaecology - from the hospital to more localized service providers;
  4. Introducing new community hospitals, which will provide diagnostics, minor surgery, outpatient facilities and the like;
  5. Piloting a new 'Life Check', to assess people's lifestyle risks;
  6. Guaranteeing patients registration onto a GP practice list close to where they live;
  7. Introducing financial incentives for GPs to offer more flexible opening hours;
  8. Increasing the quantity and quality of primary care in deprived areas;
  9. Providing a Personal Health and Social Care Plan for people to decide on the services that fit their own personal needs within a pre-defined budget (the proposed individual budgets for social care services will be piloted);
  10. Establishing a national helpline for carers.

Groups affected

Primary care and social care patients (which includes practically everybody at one point or another), primary care trusts, local authorities, hospitals


Characteristics of this policy

Innovationsgrad traditionell recht innovativ innovativ
Kontroversität unumstritten unumstritten kontrovers
Strukturelle Wirkung marginal recht fundamental fundamental
Medienpräsenz sehr gering recht hoch sehr hoch
Übertragbarkeit sehr systemabhängig recht systemabhängig systemneutral

The direction of the policy appears to be quite sensible. However, there is a danger that the NHS personnel will soon begin to experience serious reform-fatigue, and despite the very significant increases in Government expenditures on the NHS over recent years, the NHS is currently going through a period of excess spending which may potentially place a question mark over the Government's whole health care reform agenda.

Political and economic background

The Government has had quite a longstanding policy aim of better integrating health and social care to improve efficiency and quality within the overall 'care' system, and to better meet the health care needs of an ageing population with a preponderance of chronic rather than acute health problems. Whether the proposals do actually improve efficiency and quality remains to be seen, as it is becoming increasingly clear that a great many of those who work in the NHS are suffering from reform-fatigue.

Change based on an overall national health policy statement

White Papers in health care policy are rarely issued (one every two years or so), so the Government is clearly sending out the message that it is serious about these proposals.

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja nein ja nein nein nein nein

Origins of health policy idea

The main motivation for the health and social care 'reforms' probably comes from a longstanding concern about the 'separation' of health and social care, and possible 'under-investment' in social care (in England and Wales). The Government undertook a detailed consultation exercise with the general public, user groups, carers etc (in total, 42,000 people were involved in the consultation, and 1,000 people met at a 'Citizens Summit' in Birmingham to air their views) in relation to what ought to be included in the White Paper, so it does appear that the relevant stakeholder groups were involved in the policy process. This is quite interesting in itself, since it seems to be becoming increasingly recognized that a key to successful policy implementation is to involve the key potential opponents to any particular policy in the policy development process.

Initiators of idea/main actors

  • Regierung: Obviously, the Government is very supportive and very influential, otherwise these policies wouldn?t be happening. The consultation process that informed the White Paper involved interest groups, users and patients, and these groups appear to be supportive. The secondary care providers that will have their budgets constrained as a result of these policies are, however, likely to be less enthused.
  • Patienten, Verbraucher
  • Bürgergesellschaft

Innovation or pilot project

Else - The policies will be rolled out gradually from hereon. Some of the innovations ? e.g. the ?individual budgets? policy ? will be piloted initially, but the plan is that these will be introduced nationally by 2008.

Stakeholder positions

This has been discussed above. The main stakeholders were involved in formulating the policies and are thus supportive of them. To my knowledge, there has not yet been strong opposition to the policies, although some may arise (from, for example, secondary care providers), as the policies are rolled out.

Actors and positions

Description of actors and their positions
Central Governmentsehr unterstützendsehr unterstützend stark dagegen
Patienten, Verbraucher
Patients/userssehr unterstützendunterstützend stark dagegen
Elderly and disabled persons interests groupssehr unterstützendunterstützend stark dagegen

Influences in policy making and legislation

The policies have been announced, and I doubt that they will be blocked by the legislative process.

Legislative outcome


Actors and influence

Description of actors and their influence

Central Governmentsehr großsehr groß kein
Patienten, Verbraucher
Patients/userssehr großgroß kein
Elderly and disabled persons interests groupssehr großgroß kein
Central GovernmentPatients/users, Elderly and disabled persons interests groups

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The Government, primary care trusts, local authorities, the social care sector, hospitals, the voluntary sector, carers and patients will all be involved in implementation.

Monitoring and evaluation

There will no doubt be regular monitoring of the policies, and these will be reported in future Health Policy Monitor reports.

Dimensions of evaluation

Ergebnis, Prozess

Results of evaluation

Not yet undertaken.

Expected outcome

As noted in the previous report (see 6(2005)), efforts to better integrate health and social care seem warrented and may have beneficial effects on the quality and efficiency of the overall care system. I would imagine that it will, however, be difficult to provide incentives for the health and social care sectors to work together. They have traditionally operated within their own silos, and, like everyone else, are very protective of their own territories. As mentioned earlier in this report, redirecting some attention away from secondary care and toward primary care is also unlikely to pass without at least some discontent, although the focus upon primary and community care is perhaps necessary to better meet the 21st Century health care needs of the population.

Too early to tell.


Sources of Information

Department of Health. Our Health, Our Care, Our Say: A New Direction for Community Services. Department of Health,

Department of Health. Better Services and More Choice, On Your Doorstep. Department of Health, London, January 30th 2006.      

Department of Health. Dozens of new doctors surgeries and health centres this year. Department of Health, London, April 6th 2006.

Reform formerly reported in

Developments in social care
Process Stages: Idee

Author/s and/or contributors to this survey

Adam Oliver

Empfohlene Zitierweise für diesen Online-Artikel:

Adam Oliver. "Integrating community health and social care". Health Policy Monitor, April 2006. Available at