Collaboration must be designed in, not bolted on
I’ve worked in health and social care for almost 40 years - as a nurse, an advocate, and a provider. And yet, I keep asking: why are we still having the same conversations - just slightly reframed each time? The language changes, new acronyms arrive, old strategies are recycled, but the core challenges remain.
We talk about integration, collaboration, joined-up working, as though they’re fresh ideas. They’re not. What’s new is the level of pressure. Today’s workforce shortages, rising demand, and funding gaps leave little room for error and no time for circular debate.
Despite the talk, health and care still operate in parallel. Different priorities. Different systems. Different assumptions. That separation continues to undermine the outcomes we all want to see.
The Illusion of Joined-Up Thinking
Integrated Care Systems (ICSs) were meant to formalise collaboration between health and care. But decision-making power still rests mainly with NHS trusts. Social care, especially small and community-based providers, is often brought in late, if at all.
This structural imbalance has real consequences. Delayed discharges, slow care packages, missed opportunities for early intervention. And professionals with deep, local knowledge are too often left out of the room.
The result? A system that’s harder to navigate, harder to manage and worse for the people it’s meant to support.
What Real Collaboration Looks Like
Real collaboration isn’t a project or a pilot, it’s built into how we work every day. It means shared records, shared assessments, shared responsibility. It means joint training so professionals understand each other’s roles. And joint commissioning that reflects real lives, not organisational boundaries.
It also means recognising care’s role in prevention. Good social care keeps people well, stabilises conditions, and reduces demand on hospitals. But it’s rarely funded or recognised as such.
True collaboration shifts us from fragmented delivery to co-designed support - led by those closest to the person.
Barriers Are Structural—Not Personal
At local level, most professionals want to collaborate. But the system gets in the way. Funding streams are split. Risk is siloed. Time - always in short supply - is rarely carved out for cross-sector working.
In social care, integration often feels like a broken promise. The ‘and’ in health and social care is redundant. Any relationships that do exist across the divide are built through sheer persistence, hard work, and, often, gritted teeth. That’s not sustainable.
IT systems don’t speak to each other. Governance is slow. And the cultural divide between medical and social models of care still lingers.
What Needs to Change
First, social care must have equal status within ICSs - genuine involvement in commissioning, planning, and design. That means including smaller providers, too, not just the largest organisations.
Second, regulation must support flexibility. Too often, providers are punished for working across boundaries, even when it benefits the person receiving care. We need frameworks that enable, not restrict, collaboration.
Third, funding must match how people live. The current model still over-rewards acute response and undervalues preventative, relationship-based care. It’s inefficient and shortsighted.
I’ve seen countless restructures, NHS overhauls, and hospital redevelopments - some launched with great ambition, then dismantled quietly a few years later. Buildings go up, then come down. Pilot schemes appear and vanish. I can only imagine how much money has been lost—funds that could have gone to staffing, training, and real support. The waste, both financial and human, is staggering.
What we need isn’t another restructure. It’s a stable, joined-up approach grounded in practice, not PowerPoint slides.
Integration Must Be Understood from the Ground Up
Integration still feels like something that happens on paper more than in practice. It’s discussed often in Westminster, but the reality is different and that reality is felt acutely by those of us working on the ground.
That’s why it matters that decision-makers listen. When you’re invited to visit a service, speak to a team, or spend time with the people we support - say yes. These aren’t photo calls. They’re opportunities to understand how things really work and where they don’t.
There’s huge value in seeing what care looks like in people’s homes and communities. And if we start building policy from that perspective, we’ll have a better shot at designing a system that truly works.
Because really, what catastrophe is it going to take for the penny to finally drop? How many more missed discharges, failed care packages, or overstretched staff do we need before we stop tinkering at the edges and start listening to the people holding it all together?
We already know what good looks like. It’s time we stopped circling the issue and started funding, valuing, and embedding what works.
Liz is a registered nurse and current domiciliary care provider with over 25 years’ experience. She is CEO at NACAS, where she advocates for greater recognition of care professionals and a stronger public understanding of the profession.
