Wednesday 3rd June 2013

The 'straw poll', carried out by the Association of Directors of Adult Social Services jointly with the NHS Confederation, identifies widespread support and optimism for service integration, with a majority of respondents expressing a strong belief that progress on integrating health and social care will continue within the new NHS organisational structure.

But the poll identified a number of issues that need addressing before genuine integration can become widespread across the country, ranging from differences in organisational culture to practical issues surrounding payment mechanisms, and data and IT systems.

The opinion poll, which asked directors of adult social services and senior leaders in clinical commissioning groups what helped and hampered integration, found that the biggest positive contributor was strong leadership and commitment 'from the top'. More than 80 per cent of respondents said these were the most important factors at play in taking forward integration locally.

The most frequently cited factor holding up integration efforts was data and IT systems. Of the 69 survey respondents, 64 per cent said data and IT systems are an impediment to developing integrated services - a significant rise from the previous opinion poll conducted in 2010. Payment mechanisms and financial pressures were also reported as obstructions to integration progress, adding weight to respondents' calls for the Government and national bodies to lead cross-system work to ensure integration has the best chance of success across the country.

The survey indicates there has already been progress in joint working between local authorities and the new CCGs in many areas.  However, respondents reported mixed views on the impact of health service changes, with some saying leadership changes had contributed positively to integration progress, and others reporting progress had only been achieved despite the reforms' upheaval.

The poll indicates that the main driver for integration continues to be patient and service user benefit, with respondents reporting they believe service integration can have significant advantages for patients and service users. Survey participants said people receive better co-ordinated care when services are integrated and that money could be saved in the process as well.

More than half of the respondents to the survey, carried out between April-May 2013, reported that where integrated services were in place they had seen a reduction in delayed discharges. Two out of five said they had seen a positive impact in unplanned emergency hospital admissions as a consequence of integration, and the same proportion reported more service users were still at home three months after being discharged from hospital into rehabilitation.

ADASS President Sandie Keene said:

This early evidence of closer work with the health service is entirely welcome. As it develops it will have a growing positive impact in accelerating the changes we are making and acknowledging the role of social care in the delivery of effective health services, particularly for those people with long term conditions.

We should be mindful of the need to overcome the obstacles in the way, such as the lack of IT coherence between different agencies. And also, be aware of the important role strong local leadership can play in overcoming the challenges that integration poses. Overall the survey contains encouraging and positive early signs that the move towards integration is gathering pace and support where it matters most in localities and across all levels of care staff.

NHS Confederation director of policy Dr Johnny Marshall said:

"With everything going on in health and social care services over the past few months, there was a risk local leaders could have adopted a 'hunker down' mentality.  What snapshot surveys like this demonstrate is the resilience which clinicians, practitioners and managers possess to continue to focus on patients and service users. The drive to develop integrated services around users transcends organisational upheaval and day-to-day difficulties of mismatched inherited computer systems. The job now for health and care leaders is to make sure we address residual barriers so the passion of our staff to integrate care around individuals is allowed to flourish."

The full report is available on the two organisation's websites at and


Notes for editors

  1. The Association of Directors of Adult Social Services (ADASS) represents directors and senior managers of adult social services departments in English local authorities. Directors (DASSs) have statutory responsibilities for the social care of older people, adults with disabilities and adults with mental health needs.
  2. In many authorities ADASS members will also share a number of responsibilities for the provision and/or commissioning of housing, leisure, libraries, culture, and community safety on behalf of their councils. Nearly a third of DASSs are also the statutory director of childrens services for their authority.
  3. Follow ADASS on Twitter @ADASSdclode and visit its website at .
  4. The NHS Confederation represents all organisations that commission and provide NHS services. It is the only membership body to bring together and speak on behalf of the whole of the NHS. We help the NHS to guarantee high standards of care for patients and best value for taxpayers by representing our members and working together with our health and social care partners.
    We make sense of the whole health system, influence health policy and deliver industry-wide support functions for the NHS.
  5. Follow the NHS Confederation press office on Twitter @NHSConfed_Press
    A full list of NHS Confederation press releases and statements can be accessed on our media page
  6. For further information from ADASS, contact President Sandie Keene on 0113 247 8700 or policy/media adviser Drew Clode on 07976 837755
  7. For further information from the NHS Confederation, contact Georgie Agass on 020 7799 8637. For out of hours media enquiries, please call the Duty Press Officer on 07880 500726