Integrated commissioning and structural integration: the experience of Northern Ireland

Abstract

Purpose Across the UK integrated commissioning is seen as important to achieving integrated care. In Great Britain this has largely meant separate health and social care agencies coming together to assess need and the planning and delivery of services. Achieving integrated commissioning has proved difficult in the context of different funding systems and different organisational and professional values and cultures. Northern Ireland is the only part of the United Kingdom to have a system of total structural integration of all health and social care. The purpose of this paper is to examine the challenges of operationalising integrated commissioning in Great Britain and to assess whether the Northern Ireland model of structural integration has resolved such difficulties Design/methodology/approach The paper reviews how integrated commissioning is working through analysis of published research. The authors draw on policy documents to assess and evaluate the structure and process of integrated commissioning in Northern Ireland. Findings It is concluded that structural integration is not a pre-requisite for integrated care and that there may be risks to social care in moving toward structural integration. While there is a rhetorical commitment to integrated care across the UK this is not followed through in commissioning practice. Originality/value The paper presents an original assessment of the operation of integrated commissioning in Northern Ireland that has relevance for debates in Britain about the integration of health and social care.