The article below was published in the HSJ earlier this year. This decision to merge a Welsh health board into a council will drive them along the same lines being adopted by some English PCTs as they ‘de-merge’ Commissioning and Provider Arms, with some of the commissioning organisations finding some financial efficiencies through integrating with local councils.

The model proposed is even closer to that operated by the HSE (Health Service Executive) in Ireland where social care and healthcare are closely aligned (although mostly in primary care). Has this led to efficiency gains in the provision of services in Ireland? Well, it seems that whilst the relationship between health and social care in a primary setting might have been improved, the problems of a disconnect between secondary care and primary health and social care remains, and in some areas may actually be worse than having separate organisations.

The problem is the need to ensure that systems, processes and cultures are all in alignment ideally before but at worse case as soon as the organisations