Integrating Health and Social Care: State or Market?

Abstract

Medical and nursing care have been separated from social care by deliberate design since the creation of the NHS. This divide is now entirely artificial. People spend less time in hospital than used to be the case and 4 million people over the age of 65 have a life-limiting illness. In such circumstances, medical, nursing, and personal care should be combined in a range of institutional settings. Technology is also contributing to the breakdown in the divide between medical, nursing and personal care, and the institutional settings in which they take place. There have been growing calls for the greater integration of health and social care, ranging from the current government’s policy of bringing the functions under one ministry to Labour Party proposals for a National Care Service. The National Health Service is already the fifth largest employer in the world with 1.4 million people. The social care sector employs 1.6 million people. An integrated national health and care service would be the largest employer in the world. Bringing social care within the orbit of government planning and finance would lead to the creation of a centrally planned service without precedent in the Western world. However, it is difficult to achieve integration of health and social care due to their organisational structure. Competition and markets are the best way to discover how to integrate health and social care. To achieve meaningful integration, we should make the health sector more like the social care sector and move health provision closer to the models that exist in continental Europe.