Are there limits to the integration of care for older people?

Information and communications technologies (ICTs) in the domain of health are seen by national governments, including the UK, as key to the modernising of health and social care. IT solutions are now being put in place across the country and are expected to deliver a diverse set of joining-up agendas across medicine and social care, including prevention strategies, chronic disease management and the facilitation of active participation of patients and enabling personalisation of care. Against a background of the overarching policy requirement of service integration, this chapter will explore and reflect upon the recent history of the care of older people in England. It will do this through the lens of the single assessment process (SAP). SAP is intended to ensure joined-up care for older people by supporting interorganisational and interprofessional information sharing. SAP systems across England, however, are not all the same. On the contrary, they have been begun from different starting points and been implemented locally with different technologies, organisational practices and governance structures, adding up to a series of local ‘organisational aquariums’ where at any point the full range of behaviours between their organisational inhabitants are observable. We will draw upon examples of some of this diverse SAP experience to challenge the idea that the current approaches to service integration (generally point to point between statutory organisations) represent a sustainable scalable solution to the problem of sharing information and knowledge in public sector domains.

People aged 65 and over make up around 16 per cent of the UK population, but this group accounts for more than two-fifths (43 per cent) of the total budget of the National Health Service and nearly three-fifths (58 per cent) of local authority social services’ budgets (Philip 2007). Rapidly increasing demand from older people for services is one of the complex social problems (sometimes called ‘wicked’ problems) that demand co-coordinated activities across organisational boundaries or ‘holistic’ government (6 et al. 2002; Ling 2002).