For integration to mean anything, social work has to be given a stronger lead

For more than 50 years, health and social care integration has been presented as the answer just over the horizon. Since 1973, it has been promised, relaunched and rediscovered again and again. 

Yet the divide remains, not because the ambition is wrong, but because the split runs deeper than structure. A national NHS, free at the point of use, still sits alongside a local, means tested social care system shaped by eligibility, charging and scarcity. 

Any serious attempt to reimagine social work has to start there. 

I saw that early in my career. In 1997, while working in hospital social work at Addenbrooke’s and teaching on a nursing course, I gave a lecture the day after the general election in which I said I had always assumed the lack of proper integration between health and social care was largely down to the government of the day. 

I thought things could only get better. I was wrong. 

However, around that time, winter pressures money appeared. In the hospital we wrote assessments on salmon pink paper to identify patients linked to that funding. Integration, partnership and modernisation sounded impressive. The reality on the wards was far less tidy. People came with illness, frailty, housing problems, family strain, confusion, risk and poverty all mixed together. 

That is where social work has always brought something different. It does not see people as a flow problem, a bed problem or a discharge problem. It tries to hold a whole life in view. It asks whether the plan will work next week, whether the carer can cope, whether the home is safe, whether the person has understood what is happening, and whether what looks efficient on paper will survive contact with ordinary life. 

Later, working on integration in learning disability services, I was struck by how little interest people had in integration as an organisational achievement. They cared about whether they were getting a decent service: joined-up decisions, fewer gaps, less repetition, and professionals speaking to each other rather than passing people between them. 

The gains from integration are not only structural, they are human. People should not have to tell their story over and over again. Families should not be left navigating several systems that each understand only part of the problem. Unpaid carers should be seen sooner. 

The Casey Commission gives this debate fresh hope and relevance because its first phase is due to report on how to implement a national care service. This is important, but only if social work is able to shape the argument rather than wait politely at the edge of it. 

The pressure for doing this properly is only growing. It is not simply about an ageing population. It is also about complexity and a system that still spends too much time arguing over boundaries. 

NHS continuing healthcare remains one of the clearest examples. It is meant to draw a line around those whose needs are primarily health needs, but in practice it too often turns into a fight over thresholds, funding and who pays. All social workers know that continuing healthcare decisions remain a source of tension and delay. 

We have seen enough over the years to know that integration can work, but also enough to know why it drifts. For a long time we have pointed to Torbay and North East Lincolnshire because both showed what can happen when integration is given time and when social work sits close enough to the centre of the model to shape decisions rather than deal with the mess afterwards. 

But even long-standing models are not immune. In March 2026, Torbay and South Devon NHS Foundation Trust set out plans to serve notice on the current section 75 agreement, with adult social care provision due to transfer back to the council from April 2027. That does not prove integration cannot work. It shows it does not sustain itself. 

Section 75 can provide the mechanism, but it is not enough to make integration stick. Pooled budgets and partnership agreements are key, but they do not by themselves overcome divided accountabilities or guarantee lasting commitment. 

If integration is to endure, it must be built on governance, risk-sharing and shared responsibility strong enough to survive pressure, leadership change and financial strain. 

For integration to mean anything, social work has to be given a stronger lead within it. Easy to say, difficult to do, because it means shifting power, sharing risk and changing who gets to shape decisions. 

Section 75 agreements need to be locked in so parties can’t walk away when the going gets tough. In a reimagined social work world, integration would be built much closer to everyday life: neighbourhood-based, earlier, more relational and less obsessed with organisational boundaries. It would bring social workers, nurses, occupational therapists, housing, primary care and community support around the same people and the same outcomes. 

This kind of integration is practical, ambitious and long overdue. It would give social work more influence, not less, and put more of the energy where it belongs; earlier help, better decisions, stronger communities and lives that work better for the people living them.

We have been trying since 1973. A reimagined social work should not settle for announcing integration yet again. It should help build the version that empowers and feels real.

Robert Templeton is a social worker who has worked in frontline and management roles within adult social care