This paper seeks to reflect on English care trusts as an example of a structural approach to integration.
All current care trusts' chief executives were invited to participate in a semi‐structured interview exploring their experiences. Themes from the interviews were combined with findings from literature and policy review.
The current care trusts can identify a number of advantages from combining health and social care into a single organisation. Equally, they also experienced many of the anticipated difficulties, and in hindsight half of those interviewed would recommend other options to achieving better integrated working. Whilst the “commissioning” function of care trusts will not survive beyond March 2013, “provider” care trusts look set to continue and indeed expand their service delivery. They will be joined both by new integrated social enterprises delivering health and social care.
The experiences of care trusts show the limitations of a single organisational structure as a means to achieve better integration and the impact of a changing national policy landscape on local initiatives. The findings suggest that the current legal flexibilities for integrated working should remain to enable local areas to decide how best to achieve their priorities and to realise the importance of addressing local cultural, practical and leadership issues along with structural barriers.
This paper provides a reflection on the ten years since the option of care trusts were available in England and adds to the current literature which focuses on individual care trusts' development and impact.
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