Strategizing towards integration between health and social care: a case study of children's services in local government

Integrating Health and Social Care has been on the agenda of successive UK governments for over 50 years and dates back to the first National Health Service reforms of 1973. Integrating health and social care has proven to be challenging to implement at a local level. Successive governments have attempted to bring NHS bodies and local authorities closer together; however, it has been unsuccessful for a number of decades. The purpose of this study is to examine managers’ perceptions of the strategies for integration adopted, to date, in Children’s Services in Norfolk. I investigate how key decision makers understand the concept and the practice of integration and, drawing upon the Strategy as Practice (SaP) literature, consider how improvements could be made. Fourteen semi-structured interviews were conducted with participants at executive, senior, and middle management levels, followed by a thematic analysis of the transcripts. A documentation review was also undertaken to support the interview findings. Focusing on how ‘strategizing’ at inter-organisational level can contribute to improving the process of integration, my analysis results suggest that three key pre-requisites inform the process: (1) trust, (2) accountability, and (3) culture. The study also identifies a lack of middle manager inclusion in the process of strategizing at inter-organisational level. With these findings I contribute to SaP literature, specifically at a meso level, by advancing the importance of middle managers as key practitioners and the implications for inter-organisational strategizing. With regards to advancing practice, I have planned a series of engagements with health and social care leaders and managers involved in the strategy process for integration, to focus, in particular, on the way they address the top-down approach to strategizing.