Recently, I had the privilege of discussing with leaders in health care systems from all over the world why social services struggle to find their place as a keynote speaker at the International Conference on Integrated Care. A recurring theme throughout the sessions, and in the many informal conversations, was that although integrating care is a common aspiration, social care is still grappling with longstanding problems which prevent it from reaching the point where it can play its full part in this endeavour.

As someone working in policy and practice within the social services sector, I would like to offer some thoughts on the ongoing challenges we face which we need to overcome if we are serious about making integrated care happen.

Bridging sector divides

A fundamental issue is structural fragmentation. Too frequently heath and social care are funded, delivered, and commissioned through separate systems. Social services are often managed at local level while health care is often the purview of a national or regional authority. This fragmentation impacts efforts to develop joined-up care pathways.

Funding – a major misfit

Disparate funding models among different sectors and the level of chronic underfunding in social care are also compounding this problem. Healthcare is usually funded at national level or at regional level with funds directly transferred from national government, while social care tends to be financed through a combination of public funding coming from national, regional, and local levels as well as private funding, since in most cases social care is means-tested. As I explained during my keynote session, this structure gets in the way when we attempt to agree joint budgets or joint commissioning. 

The distance between the professions

There can still be a cultural and professional rift, even if structural and financial obstacles are cleared out of the way. Health care workers often think in terms of medical outcomes; social workers think in terms of lived experience and support networks. Both perspectives are necessary, but they demand mutual respect and shared language, which too often we are still lacking in many of our systems.

Lack of technology, information, and data

We also cannot overlook the technology challenge either. Far too frequently, social services rely on outdated or incompatible digital tools. If systems are not interoperable, information cannot move between systems, which then hampers coordinated care and creates an environment where the same interventions are duplicated or slip through the cracks. Incorporating digital inclusion into any integrated care strategy needs to be an integral component of the approach taken in integrated care delivery.

Workforce strains undermine gains

Finally, the social care workforce is stretched too thin. The struggle to recruit and retain professionals in social care is well publicised, but when we demand staff do more — work together more, be more innovative — without decreasing burden or increasing support, burnout is an inevitable outcome. If we want the social care workforce to be full partners in integrated care, we need to value and invest in them too.

A Way Forward

Despite these obstacles, I also wanted to send a message of optimism and encouragement. There are examples of good practice across Europe demonstrating that integrated health and social care in different forms and shapes can work when health and social services are aligned around people’s needs. For example, integrated care centres that bring together professionals from health and social care under a single organisation, intermediate integrated services between home and residential care, or joined-up mental health teams are some of the integrated programmes which already exist.

Social services play a pivotal role in integrated care for people in disadvantaged situations, yet for this care to be effective social care needs to be on an equal footing to health care. For this to happen, structural challenges such as chronic underfunding and delivery in the community need to be prioritised. What is required now is a commitment from governments, funders, and system leaders to dismantle barriers that keep us from these goals. This includes:

• Coordination of governance arrangements based on policies that place social services as true partners.
• Developing new funding mechanisms that transfer funds or fund programmes together.
• Investments in digital solutions that are interoperable across systems.
• Strengthening the social care workforce and ensure they have the resources to provide the right care. 

Integrated care is not just a technical reform. It is a different way of thinking about how we value and support people over the course of their lives. This transformation is where social care finds its place. They should have the voice, the resources, and the recognition they need to lead it.