A few months ago I wrote a structured future scenarios piece looking at four (deliberately extreme) possible futures for health and social care integration.   (There’s also a little teaser video about it).

At the heart of the paper is consideration of how the future will evolve in terms of uncertainty on two key dimensions – whether control of the system will become more local, or more centralised, and secondly whether services in future will be orotund around the user, or around professional siloes.  (It’s consideration of the extreme futures at each extreme of the two dimensions that we get to four futures – read the paper).

Since then I’ve had a chance to present about it to a variety of audiences.  I usually conclude by asking those present to give their view on where they would like us to be and where they expect we will end up.

The emerging pattern from this isn’t really surprising, but it’s worth thinking through the implications.  To a very high degree, people across health and social care like the idea of user-centred solutions, and a move away from the professional silos, but there is real pessimism about whether this will be achieved.  The role of the various pilots is very important therefore in showing what can be done.  However, there is a detectable difference between those of a health background and those of a social care background about preferences on the centralised v localised dimension.  In general health folk go for more centralised solutions, and social care folk prefer the localised.  This conforms to the stereotype that one might expect, but is interesting to think about how this plays out on the ground.  In a pilot, if the local authority folk feel that they are designing something right for their place but the health folk are seeking to develop something for national roll-out there will be a slightly different, and possibly unstated, emphasis, which may undermine the work.  I’ll be trying to test this hypothesis over the next few months.