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The article seeks to analyse the potential contribution of social work to integration debates. Social work has tended to be seen as marginal to these discussions despite the potential of social work expertise and leadership to help forge effective approaches to joined-up care. The purpose of this paper is to demonstrate how social work is well positioned to help lead and support practice focused change across social care and health. It also seeks to show how professional leadership can be a powerful vehicle for changing professional and organisational cultures.

The paper draws on practice and research evidence to demonstrate the proposition that social work can make a powerful contribution to debates about integration.

Three things could help build the cultural capital that is a pre-requisite to building integrated and joined-up approaches. First, the author needs to invest in developing the role of social workers and GPs working together as local professional and practice leaders. Second, there is a real risk that in any discussion about professional leadership and partnership, the author eclipses the singularly critical importance of engaging and involving users and carers in non tokenistic ways. Finally, the author needs to utilise better social work’s skills and knowledge in managing risk, building resilience and promoting social inclusion.

Further evaluation and research is needed about the potential for GPs and social workers to develop joined-up approaches to care for and support older and disabled people.

Social workers need to be provided with the tools, support and space in which to develop their practice leadership role, including but not exclusively with GPs.

This paper does not purport to offer any specifically originally research but rather some reflections on how social work expertise might better contribute to integration debates.

Policies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity.

The analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities.

The place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities.

This study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society.

The NHS needs to adapt as never before to maintain and plan for an integrated and sustainable multi-professional workforce, spanning all health and care sectors. This cannot happen without system leaders embracing workforce transformation at scale and enabling system-wide collaboration and support for multi-professional learning and role development. “By learning together, we learn how to work together”. The paper aims to discuss these issues.

The case studies included in this paper provide evidence of the ability of NHS systems to adopt integrated workforce models at scale. The case studies were chosen to demonstrate how system-wide change is possible, but still requires a partnership approach to innovation, strategic workforce planning and commissioner support for new models of care.

With partnership working between arm’s length bodies, commissioners, educators and workforce planners, the NHS is more than capable of generating a transformed workforce; a workforce able to continue providing safe, effective and joined-up person-centred care.

The focus of this paper is integrated workforce development undertaken by Health Education England from 2017 to the date of drafting. The case studies within this paper relate to England only and are a cross-section chosen by the authors as a representative of Health Education England activity.

The NHS needs to find ways to use the wider health and care workforce to manage an ever-increasing and diverse patient population. Silo working, traditional models of workforce planning and commissioning no longer provide an appropriate response to increasing patient need and complexity.

The evolution of the NHS into a joined-up, integrated health and social care workforce is essential to meet the aspirations of national policy and local workforce need – to centre care holistically on the needs of patients and populations and blur the boundaries between primary and secondary care; health and social care; physical and mental health.

This paper contains Health Education England project work and outcomes which are original and as yet unpublished.

Perinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer than expected women from black and minority ethnic (BME) backgrounds access care and treatment. This paper aims to address this issue.

Responding to persistent reports of patchy service provision across the UK more generally and particular concerns about potentially unmet needs among BME women, mixed‐method research was undertaken between September 2009 and March 2010. Using survey questionnaires and telephone interviews, the study sought to explore professional stakeholders' perspectives on current perinatal mental health provision and the extent to which it meets the needs of BME women. Findings from the study were intended to inform policy and plans to improve provision by establishing managed care networks (MCNs) for perinatal mental healthcare.

In total, 45 questionnaires were returned from the national survey. One‐third of respondents (n=14) consented to follow‐up telephone interviews. There was evidence of multi‐agency working among the 27 professional groups which respondents reported as being directly involved in delivering perinatal mental healthcare across the country. However, there was also evidence of disjuncture and poor communication – particularly between statutory and voluntary sectors and NHS primary and secondary care. Some respondents had difficulty defining “BME” or identifying the women to whom the acronym might be applied. They also questioned the validity of providing “BME‐specific” services. Instead, they endorsed more ethnically “inclusive models” of provision and “signposting” women to appropriate “community” services.

Taken together, these findings suggests that whilst there might be a theoretical argument for perinatal mental health MCNs, considerable effort is required if policy‐makers' aspirations for more “joined‐up” services capable of meeting the needs of all women are to be fully realised. Furthermore, current proposals for public sector reform coupled with reduction in voluntary sector provision is likely to disproportionately affect women from BME and other marginalised communities as they provide significant amounts of “below the radar” care and support.

This paper is of particular relevance to policy makers and practitioners. Findings suggest that women from BME backgrounds might be particularly vulnerable to perinatal mental illness. Contraction of voluntary sector provision increases the likelihood that the needs of BME women will remain unmet with deleterious consequences for their health and wellbeing of their families. This has potentially serious public health implications. MCNs/clinical networks have the potential to reduce inequalities by providing more “joined up” care for all women. However, the evidence base for levels of need and appropriate service response to perinatal mental illness among BME women is weak. Further research is required to bridge the evidence gap and to evaluate the impact of health and social care reform on vulnerable groups.

The purpose of this paper is to identify and review the leadership challenges in workforce planning, paying special reference to adult social care primarily in England (UK) whilst raising leadership issues that have international resonance.

This is a viewpoint which presents a distillation of key issues, challenges and relevant literature spanning workforce planning, human resources and social care.

The paper finds that growing demands on services, rising expectations for personalised care and support, together with the provision of safe and effective joined up care are some of the key drivers facing social care and wider public services. Leaders need to ensure a robust data and evidence base, sound interpretation of intelligence as well as building integrated approaches to workforce planning both within and between services.

Workforce leadership provides the bedrock to ensuring social care builds the workforce required for the future. As services undergo redesign and transformation the workforce planning task is more important now than ever and is a key responsibility for every organisation's leadership, including chief executives, commissioners and workforce specialists.

Workforce planning in social care is afforded relatively little attention and the analysis presented in this paper provides the stimulus for debate.

Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.

Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.

It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.

Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.

The purpose of this paper is to take “a long view” of initiatives taken to promote integration between local government and the NHS with the objective of seeking to understand why they have achieved consistently disappointing results.

The paper's analysis is based on an historical overview drawn from official documents and empirical research from the time of the creation of the NHS in 1948. It primarily focuses on the principles shaping the separate but parallel reorganisations of 1974 and their continuing influence up to and including the current White Paper “Liberating the NHS”, and the Health and Social Care Bill.

The fundamental sources of integration barriers today lie in the foundational principles of basing their responsibilities on the skills of providers rather than the needs of service users and their organisational forms on separation rather than interdependence, with national uniformity driving the NHS and local diversity local authorities. In addition, frameworks for integration have been established on a paradigm of seeking to build bridges at the margins of organisations rather than seeking to interweave their mainstream systems and processes.

Future empirical research will be necessary to establish whether the currently proposed arrangements for integration do, in fact, experience the same limited results as previous ones.

Local and national strategies for improving integration should be reviewed in the light of the understandings set out here and local frameworks should seek to align and integrate mainstream systems and processes as far as possible. A thorough and dispassionate analysis should be conducted of whether a free‐standing, single purpose, national organisation still provides the most appropriate structure for delivering health services in light of changing needs, care models, and resources.

The paper offers a distinctive analysis of the possible causes of disappointing outcomes from successive attempts to improve integration. If accepted, it could lead to a radically different approach, first to integration and, ultimately, to the nature of the NHS and local government.