Intended for healthcare professionals


A new settlement for health and social care?

BMJ 2014; 349 doi: (Published 28 July 2014) Cite this as: BMJ 2014;349:g4818
  1. Steve Iliffe, professor of primary care for older people1,
  2. Jill Manthorpe, professor of social work2
  1. 1University College London, London, UK
  2. 2 Social Care Workforce Research Unit, King’s College London
  1. Correspondence to: S Iliffe s.iliffe{at}

Alignment, adequacy, and affordability provide its analytical framework

A story currently circulating in English social services tells how, at the end of the world, there will be four living organisms left on our planet. Two will be cockroaches and the other two will be trying to integrate health and social care. Despite this weary practitioner view, politicians and managers see integration as the solution to the underperformance of both the NHS and local government in the care of older people with complex needs. The King’s Fund has now published the interim report of the Commission on the Future of the Health and Social Care in England (the Barker report), A New Settlement for Health and Social Care.1 It opens with a discussion of the history of relations between health and social services, makes a plea for “better integration,” and warns of “hard choices” ahead.

While the history is a useful corrective to professional and public ignorance about how health and social care have evolved, the Barker report has little to add about the mechanisms of integration across disciplines, sectors, and agencies. There is a paucity of robust systematic reviews or peer …

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