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This paper results from experience gained while developing and delivering the South Devon Integrated Care Network (ICN) and from more recent experience as an Integrated Care Pilot (ICP) organisation. It demonstrates that by taking an integrated approach a hospital can develop and prosper, and that it is possible to reduce the use of beds and manage care in the community within the levels of funding currently available. The paper focuses on integration at organisation level and proposes a model of key system drivers and controls necessary to manage an integrated health and social care system. The next level of integration is at individual customer level, and the paper discusses the enablers for this.

The purpose of this paper is to discuss the impact of demographic pressures on health and social care services and provide readers with a simple way of assessing their impact on local organisations.

The major forces affecting health systems are identified and the likely impact discussed.

It is likely that between 4 and 8 per cent of existing budgets need to be released to deal effectively with increasing demand over the next decade. Systems that work in an integrated way are more likely to achieve this.

By developing a quick numerical model, it is possible to assess the viability and effectiveness of proposed strategies.

The paper provides a quick way to think about the major forces affecting strategy enabling the reader to contribute to the identification of possible solutions.