A changing vision for health and social care integration

A key issue on the interface of health and social care service delivery is integrated care. Care integration has been a key policy focus for successive governments (Health and social care act, 2012, NHS 5 year forward, NHS Long term plan). However, full integration has not yet been achieved. The UK government has invested substantial resources into developing integrated care systems (e.g. Vanguard sites, ICS frontrunners) but progress may be limited if momentum is lost. COVID-19 has meant health and social care organisations are facing sustained pressures and have understandably had to focus on ‘firefighting’ during the crisis.

Prior to the pandemic, localised systems across England were rolling out programmes of work aiming to achieve better care integration. This is an incremental process focused on consistently building collaborative relationships between organisations with different cultures, discourses and priorities. Moving beyond organisational silos requires persistent cultural long-term change. However, responding to the COVID-19 pandemic has required organisations to redeploy resources and personnel, create and maintain crisis support services and create systems to prioritise the most vulnerable patients. Health and social care workers are exhausted and working under highly stressful conditions. We do not yet know how significant the disruption to the long-term change agenda of achieving integrated care will be and how long it will last. How will short-term virus control measures (e.g. social distancing) affect integrated practice, and how will perceptions of integration and what this might look like be irreversibly changed by long-term system changes?

Our research studying policy content evolution in UK telehealthcare (Tucker and Hendy, 2020) suggests that the impact on policy implementation could be momentous. Disruption of organisational routines can change the way that employees make sense of strategic objectives and over time may change the way that integrated care is conceptualised by those who implement it. As policy contexts shift, this can lead to misalignment in policy implementation and could lead to a scenario where frontline care workers become disconnected from an integrated care policy agenda which was previously widely supported.

To understand how and to what extent this is happening, we need to study closely the shared meaning of organisational members. By capturing and understanding these changes and understand the new shared visions for integrated care which emerge, we can bring together policy makers and policy implementers to avoid policy disillusionment and keep integrated care on the agenda of health and social care partners as they adjust to new ways of working. This is key in helping to understand how policy should change to accommodate for any shift that may have happened during the COVID 19 pandemic.

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