Integrated health and social care has featured in policies across England for the past two decades (Wilson et al, 2015). This is because joined-up services have and continue to be viewed as the primary way to simultaneously reduce duplication, improve service outcomes and achieve fiscal savings (Wilson et al, 2015; Naylor et al, 2016). This is particularly pertinent in the current policy environment, with the NHS and social care system under increasing strain to meet financial and performance-related targets (Alderwick et al, 2016).
In the past three years, the movement toward integrated health and social care has evolved. In 2014, arms-length bodies for the NHS published the Five Year Forward View (NHS, 2014). This outlines three core challenges for the NHS:
- The health and wellbeing gap
- The care and quality gap
- The funding and efficiency gap
The Five Year Forward View (FYFV) covers the period between 2016 and 2021. It aims to deliver new ways of working to meet the challenges outlined above and provide better outcomes for service users and communities (NHS Confederation, 2016). Following publication of the FYFV, NHS England and national partners launched the New Models of Care programme in January 2015. This aims to support delivery of the FYFV with 50 ‘Vanguard’ sites piloting joined-up working between local health and social care providers (NHS, 2015a; NHS, 2015b).
The drive toward integrated care was then further boosted in December 2015. This marked the publication of NHS planning guidance for 2016-2017, which included a requirement for local areas to develop a Sustainability and Transformation Plan to accelerate implementation of the FYFV (NHS, 2015c). 44 unique geographical areas, encompassing all of England, were tasked with developing a Sustainability and Transformation Plan to outline how local services would integrate in the next 5 years. Initial plans were published between October and December 2016 and are publically available (NHS, 2017a).
Following this, the Next Steps on the NHS Five Year Forward View was published in March 2017. This document states that Sustainability and Transformation Partnerships (STPs) will be the main vehicle for integrated health and care. STPs are a forum for health, social care and local government leaders to plan integrated service provision. However, STPs are not statutory bodies. Therefore, the established structure supplements rather than replaces the accountabilities of the bodies involved (NHS, 2017b). It is of note that STPs do not replace Vanguards and the planning framework is intended to facilitate the spreading of new care models (NHS, 2016a). NHS England envisions that STPs could become Accountable Care Systems that will work as an integrated system at a local level (NHS, 2017b)
Lastly, it is important to note that within the nine ‘must do’s’ for the period between 2017 and 2019 is an explicit requirement for all local areas implementing the FYFV to maintain a two-thirds diagnosis rate for dementia and have due regard for NHS guidance on improving post-diagnostic support (NHSE and NHS Improvement, 2016). This focus on dementia is interlinked with the sustainability and transformation process and continues to implement the Prime Minister’s challenge set in March 2015 to make England the best country in the world for dementia care and support by 2020 (Department of Health, 2015).