Four futures for health and social care integration - a response from Veredus

Four futures for health and
social care integration -
a response from Veredus
2015

Four futures for health and social care integration October 2015
social care integration
A response from Veredus
Foreword
What will you be doing in ten years’ time? If you’re
working in adult social care and associated health
professions, the future may seem quite uncertain.
It may be a full time job, or interim or a little light
advisory in retirement, but the main uncertainty
about your work will be the landscape. What will
health and social care look like in 2025? How
integrated will it be? Will it be locally or centrally
driven? Will we ever break down the professional
cultures within and between our organisations?
One of our team (Jonathan Flowers) recently applied
some scenario analysis thinking to the domain
of health and social care integration as a way of
articulating these uncertainties to map a possible
landscape for the future. We have taken Jonathan’s
‘Four futures for health and social care integration’
and explored in greater detail what the implications
would be for the workforce – especially the senior
workforce – and what the future might hold for
permanent recruitment and the role of interim
managers. We have augmented the original paper
with some very specific workforce thinking – which
we have highlighted in blue and added our own
conclusion at the end.
We hope this will be a useful thinking challenge
for people making their way through the career
landscape of the next decade – both in the health
and social care sector and in local government – and
for those who have to manage others and lead them
through an uncertain world.
social care integration
Why this paper?
Over the next few years, the (potential) integration
of health and social care for relevant groups such as
the elderly and others with shared needs, is perhaps
the greatest system leadership challenge we face in
the UK.
The doyen of systems thinking, Peter Senge, coined
the term ‘wicked’ to describe issues that have
high technical complexity (he called it ‘analytical
complexity’) and high human complexity. The
integration of health and social care is a ‘wicked’
problem in that it has significant technical
complexity as well as prodigious human complexity.
Complexities in the
integration of health and
social care
Technical complexity comes from the fact that there
are many possible interventions – and the evidence
base for which works best is still evolving – and, of
course, for many individuals there will be a range of
interventions, not just one. Moreover, there is the
administrative-technical issue of who pays and who
benefits from joined-up interventions.
Human complexity comes from the range of
individuals involved: professionals who have both a
justifiably proud loyalty to their particular profession
and a particular ethos; carers who might be less
informed, but are highly motivated; and, of course,
there is the individual who has primacy of legitimacy,
but whose very condition may undermine their
ability to exercise it, which therefore brings in various
formal legally-sanctioned participants.
Paul Fleming, Director
for Local Government
and Social Care, Veredus
Jonathan Flowers,
Local Government
Market Director, Capita

To those areas of complexity envisaged by Senge we
would add a third dimension, political complexity.
The integration of health and social care also
possesses high political complexity, which sets the
context in which the human and technical issues play
out. In the political complexity mix are the role of
the state; the balance of local versus central control;
the extent to which particular services should be
free at the point of need and those that should be
means tested; the changing role of the community
and family; and, indeed, an economic aspect, with
potentially productive people taking themselves out
of the labour market to provide care.
How do we approach a
problem that is more
than ‘wicked’?
So it seems we have an ‘uber-wicked’ problem. How
do we begin to tackle this and develop a shared
language with which to help us make sense of it, and
chart a course? One technique frequently deployed
to structure complexity in the private sector,
but which is used less often in the public sector,
is scenario analysis. A rigorous scenario analysis
process is not an attempt to predict the future, or
to describe what we would want to happen, rather
it is a structured process for articulating uncertainty
and for following the logic of potential futures to a
remorseless conclusion.
In this paper, we’re applying scenario analysis to the
future of health and social care.
The particular technique of scenario analysis
deployed here:
■■ considers two dimensions of uncertainty about
what the future may bring over a long time frame
– and definitely more than one parliament – say,
ten years
■■ uses these as axes for a chart that maps a
landscape for the future, as each area of
uncertainty ranges from one end to the other
■■ describes the highly extreme worlds at each
corner of the chart, and uses these as deliberate
provocations to facilitate debate.
So how will scenario planning
look for health and social care
integration (HSCI)?
Two dimensions of uncertainty for HSCI
There are many dimensions of uncertainty, and some
of them aren’t considered in this exercise, other than
incidentally. For example, the scope for disruptive
technologies (powered exoskeletons? dementia
vaccines?); or significant demographic change (major
shifts in in/out-migration following EU withdrawal?);
or major changes in societal norms (a ‘blitz spirit’
uniting the country against a compelling threat?).
Moreover we don’t consider the impact of a sudden
reversal in financial fortunes for the sector – we
assume that things stay pretty tight.
So what uncertainties do we in fact consider? We
think there are two here:
1. Whether health and social care will be highly
centrally directed or whether they will be
directed locally.
2. Whether provision will occur along service or
professional lines, or whether it will be user-
centred.
Central versus local direction
The prevailing sense currently is that the direction
of travel is away from the centre, driven by an
orthodoxy of devolution for local choices and a sense
that some knotty problems are best dealt with at a
more local level. However, it is unclear just how local
it can or will go (combined authority, local authority,
area, neighbourhood?) and, if we are taking a
long-term perspective, then it is not inconceivable
that pockets of crisis or a concern about postcode
lotteries could lead to a centralising tendency when
‘something must be done – and done now’.
Service/professional versus user-centred
The professions and their associated cultures are
very powerful, they are funded differently, and they
are held in different levels of esteem by the public.
There are thus powerful forces which would tend
to keep service provision in specialised ‘siloes’.
But, counter to this, there are: moves towards
personalisation; a desire by many to take a more
holistic approach to user/patient/client/resident
care; the residual elements of the Care Act; an
asset-based view which looks to individuals and their
support networks as a resource for that individual; a
growing focus on outcomes for the individual; and,
not least, a societal shift to technology-mediated
autonomy. By technology-mediated autonomy we
mean, to use an analogy, that we’re increasingly
less likely to simply place ourselves in the hands
of a travel agent for our holidays. Instead we
research our options – eg, on Tripadvisor – manage
our own choices and trade-offs (a nicer flight but
cheaper hotel for example), and share our own user
experiences for the guidance of others. The advent of
’digital,’ offers us myriad new possibilities.

The landscape for our scenarios
Future 4 Future 1
Future 3 Future 2
Central direction
Service/Profession
centred
Local direction of
health and social care
User centred
The diagram above shows the landscape over which
these scenarios will range, and the four extreme
scenarios at each of the corners.
On the next pages we take each scenario and:
■■ tell a ‘plausible story’ about how we could (in
principle) end up at that corner – there might be
other ways of getting there, and you may think
it is unlikely, but a story helps to make the
scenario ‘real’
■■ think about what it would mean.
Before we begin, a reminder about the ground rules
here: these are not predictions about what we think
will happen, nor necessarily what we want to happen.
If we don’t like an outcome then we can discuss how
to avoid it coming about, or how we could manage
it as well as possible, but these are simply ‘stories to
think with’, no more than that.
Future 1 – Central direction
and user-centred
Looking back from 2025, how did we end up here?
The ten years from 2015 saw a number of themes
playing out. Scandals of a similar scale and gravity to
the child social care scandals started to emerge in adult
social care too. And, as some social services began to
fail due to lack of funds, the postcode-lottery nature
of care became a major political issue, especially
when contrasted with the (relative) continuity of
service provision from the NHS. As a result, social care
services were increasingly moved into the NHS – the
ageing population demanded it, and the febrile nature
of a decade of complex political deals and marginal
governments meant that powerful voting blocs got
what they wanted.
This only increased the cultural challenges of what
become an even more unwieldy and profession-driven
structure and the management of complexity became
a huge concern. What resolved this issue in the end
was the success of the early trials in personal health
budgets, started by the NHS England chief executive
soon after he took over running the NHS in 2014. As
with personal social care budgets earlier, personal
health budgets were very effective.The vast majority of
individuals were able to manage their total care needs
or gain support from family or others, using a plethora
of web portals and support mechanisms which arose
to fill the gap. Additionally, the decline in resources
meant that top-up payments and self-funding
became more important and this nested well with
personalisation and the direction of travel for universal
credit and housing benefit.
Socially, individualism became more significant, with
these personal budgets giving more power to people
– for good or ill – in the same way as the option to cash
in pensions did, for example. A lack of local safety nets
makes regulation of provision, and national minimum
standards, very important. In 2025, individuals with
health and care (and housing) needs are assessed
against nationally-set standards, and allocated
resources, often on a means-tested basis, which they
then augment with their own money in order to access
the health and social care that they choose.
For shorthand, Jonathan has labelled this future
‘RegulatedConsumerism’.
What does this mean for various stakeholders?
In this world users and carers are the ‘sense-makers’
in the system and they have significant personal
autonomy (‘Tripadvisor rather than travel agent’).
But it leaves a problem to be resolved for those who
are unable to cope. Communities may be one source
of help in some localities, as may the third sector or
the central or local state.
For professionals and providers the challenge is
one of responding as suppliers and participants in
a retail market where they are funded as the result
of individual choices and held accountable partly
by market feedback. Commissioners’ key role is as
market shapers and makers, helping to address any
market failure, and ensuring that there is some form
of support for those who cannot help themselves.
Regulators are key in this future, enforcing and
reporting on minimum standards to mitigate the
risk of a lack of local safety nets and to provide
professionally-assessed information to the market.
But in the latter respect, regulators will be judged
on the value that they add to the user-voice market
feedback, and they will need to respond to that.
For system leaders nationally there will be the
challenge of creating joined-up policy and
interventions through quite broad tools of criteria
for assessments, and regulation, which will then
play out in quite a busy marketplace. For system
leaders locally, the challenge will be in delivering a
market of provision and/or providing services that are
consumer-responsive in ways that may be culturally
challenging.

In this world, adult care social workers currently
employed by councils would be moved into the NHS
to provide assessment services for personal budgets.
Social care management roles may not exist as we
know them today and there is a chance that there
will be limited opportunities for social workers to
progress unless they can assimilate into the NHS.
As service providers compete for users’ budgets
there is the challenge of instilling a degree of
commercialism (even if this service continues to
be provided by councils as one supplier amongst
many) and may lead to more private sector or third
sector talent (used to driving revenue and managing
donations and grants) moving into the health and
social care arena. In addition, there could be a
demand for interim managers with these skills during
the transition process. There may be a number of
services that the market will not provide and local
authorities may spin out mutuals to provide these,
as well as provide continuity of employment for
their own staff. Those that stay within the councils
may have a different role to play stimulating the
provider market by shaping the supply chain. They
will require very different skills, so initiatives such as
the commissioning academy become very important
in instilling the skillset and awareness to shape and
influence a local supply chain.
One of the challenges for the NHS will be to absorb
social workers into the system. However, it’s
worth considering whether disparity of employees’
terms and conditions may be advantageous when
managing this process. Also, as the NHS moves
towards single assessment of health and social
care there will need to be significant investment in
training and development to ensure success.
As regulators are key in this future they will need to
develop more flexible methods of assessment and
the skills to respond to the user-voice market.
Future 2 – Locally directed and
user-centred
The devolutionary drive that began during the
first coalition government of the 21st century
continued through the ‘age of the smaller state’.
Local government’s success in making cuts, and the
importance of the local political mandate in making
difficult decisions, meant that it was easy for the
Treasury to justify further devolution of services,
especially after the clear successes inGreater
Manchester and Scotland in the late 2010s. Local
government had developed a new set of tools that it
had found enabled it to make acceptable cost savings
– through evidence-based, user-centred service
change, and a focus on helping expensive cohorts to
reduce system costs as a whole. It deployed those tools
to health as well, and the local system is now very
effective at addressing people’s individual needs – no
less and certainly no more.
Convergence of professional training and gradually-
earned professional respect and demystification
meant that we saw more practices withGPs and spun
out social work practices co-located – and eventually
merged. We saw an enlightened attitude to whole,
person-centred approaches, including engagement
with housing providers.This more integrated approach
led to more preventative interventions.
But there had to be a trade off as people realised they
couldn’t have everything and tough choices had to be
made. As public health become ever more embedded
in local government it became more politicised too
– local choices for health priorities became more and
more relevant, which actually helped to re-energise
local democratic engagement. Some hospital wards
– and even whole hospitals – were closed (local
authorities had got quite good at ‘de-commissioning’).
In 2025 this does mean that there are some parts of the
country where it is better to have certain illnesses than
others but, by and large, people have come to accept
this in the way that, back in 2015, people didn’t really
challenge other local public service inequalities. Key
to this is the fact that they are – and feel that they are
– driving what happens.The ‘lottery’ part of ‘postcode
lottery’ makes it seem random, but in this scenario
people don’t feel that it is random, they feel in control.
For short this future is labelled ‘Me in My Place’.
What does this mean for various stakeholders?
In this world the ‘sense-maker’ is the local authority,
working with local partners as commissioners. It
is perhaps a simpler world for users and carers
than our Future 1 because the support is integrated
and joined up, based on local circumstances, for
the individuals. In some places that may include an
element of choice but in others it may not – this will
be a local design choice, not a national one.
Communities have a key role as being the place
where democratic discussions about relative
priorities play out, and some of the regulator
function will be in the form of local ‘scrutiny’ type
arrangements. There may also be some national
thematic regulation but the existence of legitimised
different standards in different localities will make
national regulation quite nuanced. There will be
opportunities for communities to put forward their
own solutions in areas where local politicians and
professionals take an asset-based view of working
with citizens.
Providers need to be able to adapt on a localised
basis in response to the different needs articulated by
the commissioners, and will also face the challenge
of integrating across services siloes themselves.

There are huge challenges for professionals, and
their professional bodies, in bringing this world
about, with significant changes to practice, training,
multi-skilling, cross-accreditation and more – in
fact, this is the major national system leader
challenge. The local system leader challenge is
all about operational integration to a clear and
relevant local narrative, and developing information
and policy frameworks capable of handling the
decisions required.
With all things being driven by local authorities in
the locality in the scenario ‘Me in My Place’, it will
be very important for local authorities to understand
health. With this in mind the demand for talent from
healthcare on both an interim and permanent basis
could be huge.
The fact that there would be unique local systems
has significant workforce implications. Recruiting
permanent talent with the right skills and experience
for localities could be extremely hard as each locality
may require a different skill mix. Hirers will need to
look at underlying skillsets and transferability. It may
lead to less workforce movement nationally.
The question of ‘where will the best joint health and
social care leaders come from – LAs or the NHS?’
is similar to when children’s services and education
came together in the director of children’s services
role. For many councils at that time there was a
question about whether they should have a children’s
social care or education person in post, but as time
went on this became less of an issue.
As the NHS workforce would TUPE transfer to
local authorities on more favourable terms, it may
make it hard for them to progress as salaries within
local authorities are lower for senior roles. Some
significant work may be needed on a new pay and
reward system to help prevent any hindering of
talent would also face the new challenge of working
alongside elected members to inform and implement
their locally-determined policies.
Within this future of joint working, relationship skills
will be important. Silo working has to become a thing
of the past, and the ability of leaders to ensure health
and social care systems work cohesively, by seeing
and understanding the ‘bigger picture’, will be key.
Talent, with experience in both local authorities and
NHS, will be in extremely high demand on both an
interim and permanent basis and will also come at a
premium day rate or salary.
As communities will have a key role in scrutinising
plans and decisions there will need to be investment
in skilling what are, effectively, community
volunteers. In addition, the engagement skills needed
by leaders in the systems to work with communities
will also need to be continually developed.
Future 3 – Locally directed and
service/profession centred
“But I’m only the Leader of theCouncil, it’s not as if I’m
theChair of the Health andWellbeing Board…” – that
quote to the public accounts committee was probably
the moment that, for many, represented just how far
we had come.The trend – through the BetterCare Fund
and other integrative initiatives administered locally by
the HWBs and gradually controlling, actively , more and
more of the local public service economy – continued,
and more and more funding streams got drawn in to the
purview of the Health andWellbeing Board.
However, no one ever really got to trust local politicians
with direct control of health money.The professionals
learned how to work together with grudging respect,
but there was no real integration, in much the same
way that planners, social workers and teachers had ‘kind
of got along’ when they all worked for a council, but
never really united around outcomes. Fears of litigation
abounded, and limited, the amount of multi-skilling
that took place.Various workarounds were put in
place around information-sharing – and while nobody
thought the solutions were particularly elegant,
they did, actually, work well enough.The occasional
examples of closer integration either died when key
people moved on, or proved not to be transferrable to
other places. Moreover, experiments with giving people
control over combined budgets led to many instances
where poor outcomes were achieved – the causality
and timescales required were too complex for relatively
uninformed individual choice.
By and large, here in 2025, most people are able to
find their way around the professional siloes of health,
social care and housing.The rhetoric and reality of the
smaller state has detuned people’s expectations and
they’ve decided that they don’t actually want to pay
for anything better. Pragmatically, the HWB provides
signposting and support help to those cohorts of people
with multiple complex needs where there’s a business
case to do so.
The politicisation of local health spending decisions
has led to an increasing need for local control, with all
levels of provision – apart from the very highly specialist
– gradually moving to a local council level through the
local commissioning board, the HWB.This has been
helped by the inevitable mergers between authorities,
which have created units of local accountability
that better fit with health service economies of scale
anyway.
This future has been labelled ‘Local Drift’.
Whatdoesthis mean forvarious stakeholders?
The key ‘sense-maker’ of the system in this world is
the Health and Wellbeing Board as it has evolved
by 2025. While it is driven by the council, which
provides that element of democratic input, there

are also other professional voices influencing the
local commissioning. There is scope for involvement
by local communities, but only if the HWB/
commissioners let them in.
For users and carers there is the challenge of
working across a disparate system, though this
may be mitigated a little for those with the most
complex needs, due to local commissioners having
an incentive to save money through interventions
joining things up for those individuals – eg, an
intermediary or adviser to work the system on
their behalf.
Providers are likely to remain organised around
service lines, but will need to adapt to local
circumstances. Providers who can offer joined-
up solutions will be welcomed if they can devise
procurement ways of accessing the multiple
funding streams.
For regulators, while they can benefit from the
relative simplicity of being able to regulate individual
services/professions, they will need to adapt to
regulating in a context of no national standards,
‘though there may still be nationally-imposed
minimum standards. Regulators could play a
value-adding role in this world by offering nationally
benchmarked assessment to aid local commissioners.
The system leadership challenge here is very local,
and is about governance and commissioning across a
number of independent strands, ensuring appropriate
information and relationships exist to facilitate this.
This future is probably the closest to our current
situation. It would be right to assume different
localities will have different expectations around
HSC outputs – eg, different AE waiting targets or
referral to treatment times. Any talent from health
and social care who are moving around localities for
work will need to be able to quickly understand and
adapt to new systems and priorities.
In ’Local Drift’, the knowledge to work around the
system is key – in particular using strong personal
local relationships and networks to get desired
outcomes for the public. It may well be that we
would see less movement in the workforce market in
this instance as only local people will have developed
the long-term trust relationships to make things
work. As opposed to being change deliverers, interim
managers may be more frequently used in this
future, acting as an ‘honest broker’ when there is a
breakdown of a relationship.
There is a likelihood of fewer external hires to senior
leadership roles as it could be perceived as less risky
for a deputy to take over as a leader as they will
already have developed a network locally, rather
than someone from outside the locality who has to
start afresh. So succession planning will be critical, it
can’t be left to chance or the market –‘growing your
own’ and developing a pool of talent to take over is
a must. The challenge with this is that it goes against
the public sector mantra of ‘equal chances for all’
in getting new roles. Managing perceptions of the
merits of appointments will be very important as
a result.
Where this may get interesting is if the best
‘internal’ candidate is someone working for a local
partner organisation – we may see people moving
from senior roles in adult social care to run the
CCG, or vice versa. It may be that the lowest risk
appointment is someone from a different sector, but
who has those vital local relationships.
Future 4 – Centrally directed
and service/profession-centred
All the signs were there back in 2015 – and earlier.The
resources available for social care – especially adult
social care – simply reduced and reduced. Councils
got better and better at ensuring that their service
users were accessing every possible national source of
support, helping them to apply for benefits to which
they were entitled, and so nationally-sourced benefits
became an ever-more important part of the mix.
For central government, rather than addressing issues
through more council funding, it became easier (and
felt more targeted) for successive administrations to
keep the hard cases out of the headlines through the
benefits system, offering top-up payments to those
in need through tax credits, means-tested benefits
or nationally assessed schemes. Moreover, by having
control over all of the purse-strings it was easier for
central government to move money around based on
policy priority changes.The newly created Department
for Work, Pensions and SocialCare is a large
government department with a very different ethos
to that of the Department for Health. In some cases,
having a qualifying claim for support means receiving
some form of financial benefit to access services from
a market, in other cases it means receiving a nationally
commissioned service, locally delivered.
The difference between the ‘benefits’ mentality and
the ‘universal service’ provision of health exacerbated
the difficulties of bringing the professions more closely
together, and the user experience of these services is
quite different in 2025. Self-funding for social care has
become significantly more important and we are at last
seeing signs of people making provision for future care
needs as a result. Social care now is a little like housing
was back in 2015 – relatively limited state-provided
(social housing), and means-tested benefits helping
people access private provision (private rental). In
this analogy the role of the housing association is
taken up by social care spin-out organisations that
have managed to achieve independent viability as
alternatives to the private market and which are
no longer state-controlled. Such organisations do
exist in 2025 but they are operating in a much less
certain world (and without the asset base and revenue
certainty enjoyed by housing associations).

Public spending savings have largely come from
reducing social care funding, rather than from
preventative investment and the joining up of services.
It suits many of the national lobbying groups and
charities to be able to campaign for changes at a
national level, and they can be very successful in
drawing attention to specialist needs which may not
have a voice in a more localised situation.
This future is labelled ‘Careasa Benefit’.
Whatdoesthis mean forvarious stakeholders?
The ‘sense-maker’ in this world – by default – is
the individual and their carer/family and is quite
polarised between self-funders on one hand and
‘claimants’ on the other. Despite the central control,
the experience on the ground may be quite different
depending on the level of provision in different
areas and the range of provider options. Some
communities will be willing and able to support
people in navigating the system, and some may be
able to offer top-up care, but this will vary widely.
Providers may find more scope for nationally-let
contracts, and national frameworks, and regulators
will be able to work to national arrangements too.
Health commissioners proceed as now, influencing
whatever joining up they can, but social care
commissioning becomes more akin to determining
benefits policy and operationalising assessment
and means-testing. The social care profession on
the assessment side becomes more akin to benefits
assessment than ‘care package provision’ and this
would be a significant cultural change.
System leadership is very difficult in this world – it
becomes a very deep policy question nationally, and
individual local ‘civic entrepreneurs’ may occasionally
be able to achieve system results.
Health would stay as is in the ’Care as a Benefit’
scenario, but there would be huge change for social
workers. Social workers would be more focussed on
benefit assessment rather than identifying a package
of care. Those with a hands-on caring motivation
we expect to move in to a provider role, leaving
assessment to others.
As benefit assessment becomes a more mechanistic
process it means other professionals would be able
to deliver it. It could well be that staff in job centres
become the benefits assessors in this scenario.
From a leadership point of view, you will effectively
have two camps. On one side you will have process-
focussed leaders and on the other it will be all about
the delivery of quality care. Arguably the strongest
leaders in this scenario will have a mixture of both but
the polarisation of this model potentially inhibits this.
Conclusion
We remind you that the ground rules of this exercise
are that we are not predicting the future – these
futures (summarised in the diagram overleaf) are not
necessarily what we think will certainly happen, nor
do we necessarily find them desirable.
None of these futures is likely to play out to the
deliberately extreme extent to which they are
described. However, unless we remain exactly where
we are now we will tend towards some of these
futures more than others, and this thinking helps us
to get ready. We may find a blend of these futures
emerging – within the UK we may find different
models in the different nations – and we may find
that there is a default national picture that strong
local areas are able to become exempt from, to do
their own thing.
However, the nature of scenario analysis is not to
make firm conclusions – that defeats the point.The
purpose of this paper is to provide a framework for
discussion, and for relevant leaders – whether they be
commissioners, providers, regulators, local or national
politicians – to consider how the world in which they
must lead may change over the next ten years.
With this in mind, what can be learned from
considering each of them from the point of view of a
professional working within health and social care?
The workforce will need to change and adapt to
emerging care systems and will need to be prepared
to work more cohesively at both a local and/or
national level.
During the 10 year transition phase there will be a
demand for systems leaders with commercial and
health and social care experience. Some may already
exist in the system, but others will need to be found
or developed. When hiring, organisations will need
to develop improved attraction and assessment
methods to ensure they find talent from across
sectors with the right skills and leadership style

If you would like to discuss what these potential futures could mean for you, please
contact Paul Fleming at paul.fleming@veredus.co.uk or call on 0113 382 3699.
Central direction
Profession/Service
centred
User centred
Local direction of
health and social care
Care as a Beneﬁt
Social Care funding happens through national
beneﬁts administered by the Department for
Work, Pensions and Social Care. The NHS is
sacrosanct.
Regulated Consumerism
The Department of Health and Social Care and
the National Health and Social Care Service
preside over a personal budgets-driven
marketplace of individually commissioned
provision.
Me in My Place
User-centred solutions are developed locally
based on local priorities on behalf of the local
population.
Local Drift
Commissioning is increasingly localised. Service
integration doesn’t take place but the
workarounds are ‘good enough’.
to deliver success. Executive search and interim
management providers with a cross-sector reach and
understanding will be well placed to support them.
In most of the scenarios the investment in training,
developing and changing the workforce culture during
the transition periods will be huge, but equally the
return on this investment could be significant.This
period would create opportunities for talented interim
and permanent leaders with experience of planning
and delivering change locally, regionally or nationally.
Social care professionals who want to ‘future proof’
themselves for the different eventualities should be
taking action now.They should take up opportunities
to understand other parts of the system and
proactively develop relationships in the wider health
and social care system to help overcome the potential
challenges of the future.

Four futures for health and social care integration - a response from Veredus

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Four futures for health and social care integration - a response from Veredus