Observations Body Politic

Fasten your seatbelts for integrated care

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7487 (Published 16 December 2013) Cite this as: BMJ 2013;347:f7487
  1. Nigel Hawkes, freelance journalist, London
  1. nigel.hawkes1{at}btinternet.com

It’s going to be a bumpy ride, if Northern Ireland’s experience is anything to go by

When everybody agrees what needs to be done it’s usually too late to demur. Conviction has taken hold; belief is behind the wheel, eyes bulging like Mr Toad, scattering pedestrians out of the way. To express doubt is to be taken for a fool.

This brings me to integrated care, the panacea for all that ails us. The NHS in England has promised to dip into its diminished exchequer and transfer several billion pounds a year into social care, in the conviction that this will improve the experience of patients and maybe save money. In a recent poll 83% of leaders of clinical commissioning groups said they believed that pooled budgets would create better integrated care.

Maybe they should take a look at Northern Ireland, which uniquely among the four UK nations has had pooled budgets for several decades. Its experience has been ignored but is far from encouraging. Without in any way disparaging the efforts made there in very difficult political circumstances, pooled budgets seem to have done little or nothing by themselves to integrate health and social care. On a recent visit I was reproved as naive by one senior official for …

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