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Britain's care system is at an inflection point. Changing

demographics and disease patterns - allied to rising public

expectations and dwindling public resources - are calling

into question the very sustainability of how health and

social care is delivered in our country. Muddling through

for another five or 10 years will no longer do. Something

has to give.

This important report sets out useful proposals to address the problems faced by

our health and social care system. It is welcome that the notion of integrating

services around the needs of patients and citizens is fast becoming a new

orthodoxy in public policy thinking. An older population with a high level of

co-morbidities makes a nonsense of the current sliced system of care split as it is

between primary, community, acute and social care. So too does the incidence

of physical health problems amongst those in need of mental health services.

Patients rarely fit the pigeon hole in which they find themselves.

It is time to turn the system on its head by starting with the needs of the patient

or citizen. They should not have to fit the care system. Instead, it should be

built around the very different needs of individual citizens. We are a very long

way from that being the case today. Social care has accountability structures,

funding methods, management structures and data systems that are separate

from its health care cousin. Yet they are part of the same family of care. It is time

to find ways of putting them closer together.

Doing so will not be easy. Change never is. It will require a new clarity of

direction and the courage to do things differently. In the NHS, new models of

care are now actively being built. But the NHS cannot do it alone. Leadership

that is willing to embrace change is needed at every level. That is why it is so

welcome that local government- which is busy reinventing and rejuvenating

itself - is also stepping up to the plate.

It gives good grounds for optimism that our care system can be reformed and


The Right Honourable Alan Milburn, Former Secretary of State for




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