Authors: Hultberg E, Glendinning C, Allebeck P and Lonnroth K

Journal: Health and Social Care in the Community, 2005

Volume/pages: Vol 13(6), pp531-541

About the study

This paper reports the findings of studies from England and Sweden exploring the impact of pooled budgets for health and social services. The English study focuses on the impact of flexibilities introduced in the Health Act 1999, while the Swedish study looks at the effect of the Socsam legislation. Funding arrangements in the two countries are described, and the findings of the two studies are presented, with reference to the wider implications of the evidence for improving collaboration between services.

Findings

The English legislation was examined by Glendinning and colleagues using a postal survey at two stages, 18 months apart, with the first 32 localities to use the flexibilities. The Swedish legislation was evaluated in eight trial areas, in a government-funded study which used a range of methods including interviews and questionnaires. The approaches were found to have some similar, and some contrasting, attributes, but evaluations of both revealed: strengthened horizontal relationships; initial resistance relating to different professional cultures, which was resolved over time by dedicated managers; and a lack of clear evidence that interdisciplinary collaboration resulted in improved outcomes for service users. Neither study provided strong evidence of the outcomes of integration.

Key Messages for practice

• "Integration costs before it pays" (Leutz 1999) "“ i.e. reorganisation can be costly, and any potential positive outcomes will come later, if at all

• There is no definitive evidence in this paper that integration leads to improved outcomes for service users

• Pooled budgets are an important way of facilitating improved integration of services, but they must take place alongside other measures.