Health and social care systems

This chapter reviews the organisational changes in the delivery of health and social care. These significant system changes provide a backdrop to current challenges in moving towards an integrated system of health and social care. The chapter discusses challenges related to NHS services being free at the point of use and their integration with means-tested social care. Working in Greater Manchester, the authors show how one of the first UK regions in which health budgets have been devolved to the local authority has allowed the development of governance arrangements and agreed strategic plans across the health and social care sector to promote relationship building. These developments have been underpinned by politically driven reorganisation. The Greater Manchester Partnership has increased the possibility of dealing with the complexity of 'wicked issues' (related to individual and community needs), supported by a Transformational Fund. The wider determinants of health perspective, as proposed by Dahlgren and Whitehead's 'rainbow' model, have been useful in developing holistic responses; these include considerations of transport, housing, and unemployment, among other determinants.