Market forces are the best way to successfully integrate health and social care, says new IEA report


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IEA report encourages more competition in health & social care systems

Competition and markets should be introduced into the UK’s health and social care systems to find the best ways of integrating the two sectors, according to a new report from the Institute of Economic Affairs.

A ‘National Care Service’ is not the solution to providing better health care overall in the UK. The health sector is largely centrally planned and delivered, while the social care sector is split across a mixed economy of charities, families, local and central government, and profit- and non-profit making groups. Bringing the two together under one centrally planned service would be unprecedented in the Western world.

Author of the report, Professor Philip Booth argues that the only way to facilitate better outcomes in terms of patient care and efficiency, is within a system that allows more competition in healthcare provision with different organisations integrating health and social care according to the preferences of their customers and clients.

The development of technology can and should lead to further integration of health and social care. However, our centrally planned health system is a barrier to any meaningful integration. At a time when more and more conditions can be assessed, monitored and treated using apps, remote monitoring, treatment and care outside hospital settings, the differentiation between health, nursing and social care is becoming much less clear.

The way in which the UK’s health system is run has not really changed over the past 50 years, despite the drastic technological advancement we have seen in that time. The basics of diagnosing a medical condition still start with a 10 minute, in-person consultation with a GP.

Health, nursing and social care

  • Health and social care have been separated by deliberate design since the creation of the NHS. That divide is now entirely artificial and highly problematic.

  • Today, people spend far less time in hospital, and four million people over the age of 65 have a life-limiting illness which requires continuing care, but not necessarily institutionalised, nursing care.

  • Therefore health, nursing and social care should be combined in different ways in a range of institutional settings and, where possible, in the home.


  • Growing calls for greater integration of health and social care will be likely to involve increased state control, either through the current government’s policy of bringing the functions under one ministry, or the Labour Party’s proposals for a National Care Service.

  • The NHS is already the fifth largest employer in the world, with 1.4 million employees. It is the third largest employer that is not an army. The social care sector employees 1.6 million people.

  • An integrated national health and social care service would be the largest employer in the world and bringing the whole health and social care system under central government control and finance would be without precedent in the Western World.

  • Instead of creating a centralised behemoth, competition and market forces should be used to discover the best ways to integrate health and social care.

  • Pluralism in both sectors can provide different services which meet the different needs and preferences of patients (for example, whether home or hospital based, whether to focus on care or medical treatment, and the extent to which technology is desired).


  • Technology is also changing and breaking down the barriers between medical and nursing care.

  • Smartphones, for example, can be used to monitor medical conditions whilst assessment takes place remotely. Phones can be used to monitor glucose levels in diabetics and to control insulin uptake more precisely.

  • As technology leads to the development of new ways to provide health and social care services, ways to combine the two will become clearer and more realistic, especially in hospital settings.

Commenting on the report, author and IEA Senior Academic Fellow Professor Philip Booth, said:

“As technology in the field of health and social care develops at a rapid pace, allowing much greater integration of health and social care, we have structures of delivery that are preventing much needed change. Such change would reduce costs and provide much better services to patients. Calls to integrate health and social care in a comprehensive state-run system would create a centrally-planned organisation without precedent in the Western world.

Instead, we need more pluralism and competition in healthcare so that providers can offer different approaches to health, nursing and social care which removes the artificial barriers between them that were imposed at the outset of the NHS.”

Notes for editors:

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To download the IEA’s report ‘Integrating health and social care’ click here.

Previous IEA research on health care – Universal healthcare without the NHS and A Patient Approach – is also available to download.

The mission of the Institute of Economic Affairs is to improve understanding of the fundamental institutions of a free society by analysing and expounding the role of markets in solving economic and social problems and seeks to provide analysis in order to improve the public understanding of economics.

The IEA is a registered educational charity and independent of all political parties.