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Ian R Smith and Professor Stephen K Smith

Away from the past and to a sustainable future

How the UK’s health and social care systems can be reformed to better align with the needs of today’s society

A crisis is looming in health and social care in the United Kingdom. The population is ageing, the prevalence of chronic ill health increasing, and demand is rising at the same time as funding falls. Parts of our system are already operating at crisis point, yet the pressures are only set to increase.

Health and social care systems have barely changed since they were founded in 1948. Society has changed hugely, however. The result is that we have a system badly misaligned with the needs of the society it serves. This is not a sustainable state of affairs.

This pamphlet explores the nature of this crisis, diagnosing the reasons behind this misalignment. It goes on to posit a solution: the introduction of integrated care organisations (ICOs) closely aligned to academic health and science centres (AHSCs).

ICOs will remove the artificial and unhelpful boundaries between different parts of the healthcare service, and between health and social care. They will meet the needs of a population which is living longer and with more chronic conditions, and move care away from our overwhelmed hospitals.

Through alignment of these organisations with academic health and science centres, meanwhile, it will be possible to improve clinical outcomes and deliver precision medicine – and to sustain the UK’s position as one of the world leaders in genetic medicine.

There will be barriers to instituting such a change. Many are stubborn, and are the reasons why our system has been stuck in the past for so long. In these pages, we identify what these obstacles are. Importantly, we then explain how they can be overcome.

We have little choice but to take action. Unless we do, there is a real risk of catastrophic failure in both the NHS and the social care system.

Away from the past and to a sustainable future

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