Rearranging the deckchairs on the Titanic of long-term care - is organizational integration the answer?

Abstract

Since 1997 the British government has actively promoted collaboration between health and social care services, culminating in proposals for fully integrated health and social care organizations -called Care Trusts - to address problems in co-ordinating services for older people. This paper draws on historical evidence to examine the origins and development of these difficulties. A consistent theme over the past 50 years has been the changing role of health services in the provision of long-term support for older people and the consequent redefinition of the boundaries between health and social services. However, these changes have largely not been matched by corresponding transfers of resources that might enable social services to meet their increased responsibilities. Moreover, the demands of the acute hospital sector risk marginalizing the social support valued by older people themselves. The paper argues that organizational restructuring will therefore fail to improve coordination between health and social services for older people unless these underlying issues are also addressed.