Ahead of the 26th International Conference on Integrated Care, Professor Robin Miller speaks to us about the common gap at the heart of integration: social care.
Robin Miller is the professor of collaborative learning in health & social care at the University of Birmingham, this year’s lead conference partner.
What is exactly meant by integrated care?
Integrated care is trying to promote better collaboration between different parts of the health and social care system. The aspiration is to put people and their families at the heart of decisions about their care and support, and to ensure that the various professionals and practitioners who are involved with them listen to what they’re saying.
It works at different levels of the system. People’s experience of integrated care is the most important, but to achieve it you’ve got to try and plan and use services in a more joined up way. Otherwise, you can sometimes get duplication, you can sometimes see gaps between services, sometimes services don’t understand what the other professionals are doing and therefore, they don’t work together better.
So it works at different levels of practise and service management and policy.
Could you explain how social care connects to this?
One thing to say is that the general aspiration for professionals and services to work together is not a new one, it’s been around for at least 40 years in England and the UK. But despite the fact we’ve seen the importance of it, over all that time, we still struggle to achieve it consistently for people.
Often, the focus has been on how hospitals and community health services can work together, which is really important, and there’s also been a focus on how professionals, such as social workers and occupational therapists, can be part of multidisciplinary teams.
Image: The 2023 ICIC Conference, hosted in Belgium
But what has been less recognised is the important role of people who provide direct social care – so people working for domiciliary care agencies, residential care homes, supported living, or personal assistants employed by someone with a disability. They’re the practitioners that actually see someone on a day-to-day basis, but integrated care policy generally doesn’t recognise their contribution as much as it should.
Given your experience in health and social care research, you must have some views on how integrated care could be improved?
I think the first thing is we have to genuinely put people at the centre; that relates to their own care and the support they and their families have.
It also relates to how we plan and spend our money. We have very limited engagement with people in terms of thinking of priorities for investment, but we have to involve them so that we’ve got different perspectives.
So, that’s one thing we have to do. The second thing is recognise the challenges. Often, we hope that by putting professionals together in a multidisciplinary team, things will be more joined up. But this isn’t always the case, because we might not have the right mix of professionals, the right leadership in the team, or the ability to resolve conflicts. Therefore, whether these teams collaborate successfully often comes down to a bit of luck.
There’s also a policy level, in terms of giving people the flexibility to use local budgets in a more joined up way and to be fair, successive governments have tried to do that. The Better Care Fund is a good example, where the government said, ‘You can only have this money if you use it together and focus on priorities that matter to health and social care.’
So it does happen, but not consistently. In these really rough times, with capacity, workforce and rising demand, it’s hard. In such situations, what we generally do is stick to the basics: focus on our core business and avoid taking on others’ anxieties. The problem with that approach is that it makes it much harder to improve how we use the finances.
With the Fair Pay Agreement expected to pass in 2028, how do you assess its potential impact?
I think it’s great that there is better recognition of the contribution of carers, they do an incredibly skilled role that adds huge value to society, and they don’t get paid enough for it. The issue is, do local authorities have the funding to meet those additional costs?
Image: The 2024 ICIC Conference, hosted in Belfast
I think the general consensus is they don’t, especially with the local authority shake-ups happening this year and integrated care boards merging. They are responsible for planning integrated care across different regions and they’re having to consolidate and lose half their staff.
Although the government has set up some sensible structures and policies, it’s very hard for people to put them into practice in such a context. But what I would say is positive, is that we still have some really good initiatives such as health and wellbeing boards in each local authority area, and primary care networks where GPs and primary care professionals come together with social workers to plan for their populations.
You’ve conducted research in Australia, Sweden and Canada. Have you come across any ideas in social care that you think we could learn from?
Yes, I think some of the Scandinavian countries have a much greater role for their municipalities in terms of planning and delivering healthcare along with social care.
There’s some good examples in Canada of multidisciplinary team working. In Toronto, they have teams that come together and they’re trying to match those to local populations. It’s never a one-size-fits-all approach, it’s genuinely trying to think, What are the needs? What are the communities we’ve got to support?’
Ultimately, what you have to do is to have a structure that gives people the platform to collaborate together.
One of the projects we’ve just finished is on something called Community Hubs, where health and social care professionals and the voluntary community sector are based in community buildings. So that could be a library, a sports centre or a faith building – the idea is that these spaces are more accessible to the public.
Over the last four years, with the National Development Team for Inclusion, we have been evaluating community-led support, and over the last two years we’ve focused on community hubs.
People are really positive about the difference it makes and highlighted how important it is to be clear which communities such hubs are trying to reach. If not, there is a risk that they are busy, but not accessed by people who are often marginalised from mainstream services.
Speaking of support, can you tell me about the 2026 International Conference on Integrated Care
Of course. The conference is the biggest international conference on integrated care in the world and it’s coming to England for the first time, which is very exciting.
It brings together practitioners, policy makers, researchers, community groups and people with lived experience who’ve got an interest in how we can better collaborate and integrate care.
The focus for this conference is diversity and inclusion – the reason we’ve picked that topic is because I think often integrated care internationally doesn’t sufficiently think about the range of communities and how it can respond positively to how they are changing.
Image: University of Birmingham – where some of this year’s conference will be held
It’s also thinking about diversity workforce, so going back to the point I made at the beginning – it is about professionals, but it’s also about social care practitioners and those who deliver social care and those working in the voluntary community sector.
The conference is also a good chance to showcase what people are doing, because there is a lot of good work that doesn’t get recognised in England and the wider UK, particularly by social care providers. It’s also a good chance to meet people, develop networks and potentially connect with others to build new collaborations.
It is taking place on 13th-15th April in central Birmingham and has been set up by the International Foundation for Integrated Care. We’re also involving practise partners in the West Midlands and national bodies such as ADDAS, the Local Government Association, Care Quality Commission, the Kings Fund and NHS Confederation.
I’m super excited for the event because social care is a vital part of the integrated care system, but it isn’t as recognised and as celebrated as it should be, and I think the conference will really shine a light on that.
More details about the conference can be found here.
Images: Robin Millar and the International Foundation for Integrated Care
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