Integration and the NHS reforms

Purpose - The purpose of this paper is to consider whether the framework for integration initiated by the White Paper Liberating the National Health Service (NHS) is likely to be more successful than previous frameworks. Design/methodology/approach - The paper formulates ten principles of integration derived from a historical literature review, and makes the comparison with principal features of new proposals for promoting integration between NHS and Local Government in England. Findings - There is a relatively good fit between the principles and proposals but gaps were identified and implementation difficulties are already becoming evident especially in respect of the tension between localism and national accountability. Research limitations/implications - The conduct of the literature review is consistent with standard historical research methods but does not aim to comply with the protocols for systematic reviews in health sciences. It does not attempt to be based on a fully comprehensive search because of the time and other resources associated with its commissioning. Future empirical research will be necessary to establish the actual impact of the proposed legislative changes on relationships between the NHS and Local Government together with any changes to health and wellbeing outcomes at local level. Practical implications - Local and national strategies for improving integration should be reviewed in the light of the principles set out here. Originality/value - The paper should be of value to policymakers and policy analysts seeking to understand more systematically the implications of the current legislative proposals in the context of previous empirical and theoretical knowledge. It will also be of value as an up-to-date analytical account of an important dimension of the proposed health reforms in the context of longer term historical understandings frequently missing from the organisational memories of health and social care agencies.