I feel that there is a lot of “hype” concerning integration of health and social care services, and I do not wish to reinvent the wheel by offering the same definitions and the same process maps.

However, I think the challenge is at a number of different levels. First of all, I think that there needs to be a cultural change whereby the medical and social care cultures meet somewhere. Moving towards a culture where the health and social care needs, both medical and welfare, meet requires some understanding of why and how the cultures are different. There are a number of contributing factors, but it is hard to escape from the inherent difference in organizational structures and functions, personnel, training, budgets, to name but a few. Again, this brings up the problem of the extent to which managers can manage in the NHS without direct experience of how patients are clinically managed in the NHS.

Secondly, there is no doubt that logistically a NHS, fit for purpose, faces a massive task in being operationally ‘fit for purpose’. We all know about the disaster which was the NHS IT project, but certainly we need a health service where exchange of information between hospitals and primary care, and other institutions, needs to be much more easily achieved, and serious consideration to be given how much (if all) of it is to be shared with the patient himself or herself.

I personally don’t wish to move to a world where patients are somehow incentivized to receive the cheapest possible healthcare at the expense of quality, so I think it’s really important that integration is not used to ‘sell’ healthcare from suppliers to the patient in an unnecessary way, either directly or indirectly. I think it is necessary to have a discussion of how a complex patient with multiple needs is best served by a range of medical and other healthcare professionals, but I am mindful of entering into this discussion at the end of a traumatic £3bn organization. If there is to be a realistic chance of producing a cultural change towards integration at all, it is imperative that we do not repeat the same mistakes which threaten to engulf the NHS reorganisation just enacted. To ignore the principal stakeholders (NOT the private healthcare companies BUT the BMA, RCN and other medical colleges) would produce yet another catastrophe, however planning goes into this from thinktanks or management consultants.