Integrated Care and Structural Change in England: The Case of Care Trusts

Integrated care for vulnerable people is a target of governments throughout the world, but one that is thwarted by organizational and professional divisions. The 'New Labour' government in Britain came to power in 1997 with a brief to secure integrated support across health and social care through the development of partnership working - part of its much-vaunted 'Third Way'. However, just as new legislation on partnerships came into effect, the government attempted a volte-face and sought an alternative policy - the imposition of structural change. This article looks at the origin and nature of these alternative approaches. The political furore accompanying the change is examined and an attempt is made to apply an evidence-based approach to the main vehicle for structural change - Care Trusts. Ten reasons are suggested for treating the proposed model with caution. The analysis has relevance for the debate elsewhere between the relative merits of partnership working and structural integration as alternative ways of securing integrated care.