For those responsible for leading integration, it will not come as a surprise that some areas are getting a bit stuck. Whilst there is still widespread support for integration, there are real disagreements in some places about how to achieve it. In the worst cases, relationships between Councils and Clinical Commissioning Groups (CCGs) have broken down.
This is obviously a cause for concern, because we can only develop integrated and coordinated care if people and organisations work together. It needs people leading change to think beyond their own organisations and consider the wider health and social care system; they need to become 'systems leaders' to use NHS England's language of choice. Systems leadership is when leaders commit to leading change not just within their own agencies but across the whole health and social care system.
This is not to say that some dramatic progress is not being made. In Northumberland they have delivered a 36% reduction in emergency admissions through the creation of a fully integrated frail and elderly patient's pathway. In Leicester they have significantly reduced delayed transfers by creating an integrated crisis response team, along with local area planning teams. And in Hertfordshire, where the CCG and local authority have created one of the largest pooled budgets in the country - £230m - they are seeing innovative schemes like HomeFirst reduce emergency admissions.
The reasons for the success of schemes like these are usually many: good recruitment; effective multi-disciplinary teams; integrated information systems; and excellent service user involvement. But underpinning all of these examples of good practice is excellent leadership.
So in places like Hertfordshire, you have a cadre of leaders who are committed to working collaboratively, even when circumstances are difficult. According to Iain MacBeath, Director of Health and Community Services for Hertfordshire County Council, because leaders have been willing to make joint decisions, often about difficult issues, a culture of trust has developed between them. He writes: 'This mutual trust we have means we just get on with things and spend money where it will have the biggest impact.'
And in Leicester, dramatic improvements have been put down to 'leadership at all levels' with agencies pulling together to find solutions rather than looking to blame each other.
Delivering integrated care is proving to be a much harder task than perhaps most envisaged. To make matters more challenging, tough financial conditions can also can have a polarising effect, pushing partners apart rather than together. That is why we need to recommit to a collective approach to leadership, with leaders willing to share power and to solve problems together rather than always working in isolation.