Seeking greater integration in the delivery of health and social care has been a longstanding aim of different governments over time, yet deepseated and seemingly intractable barriers remain. While the Coalition has stressed the importance of integrated care and introduced a number of new initiatives, it remains open to question as to whether health and social care are more or less joined up than they were in 2010. Against this background, this chapter begins by summarising the state of play at the end of the New Labour governments of 1997–2010 and the main reforms introduced under the Coalition government of 2010–15. After this, the chapter considers the emerging evidence about the impact of the Coalition's policies, and offers some initial thoughts on how such developments might be interpreted. Given limited formal evidence and the fact that the two authors have been actively involved in some of the policy debates described, the chapter draws on both formal and informal sources of knowledge, and seeks to combine a review of the published data with some more personal reflections. In the process, a ‘three stream multidimensional policy implementation framework’ is used to critique the implementation of integration policy by the Coalition (Exworthy and Powell, 2004). As the title of this chapter implies, it is relatively easy to make a rhetorical commitment to greater integration (in one sense, who would argue for greater fragmentation?) – but delivering this in practice is much harder.

Health and social care prior to 2010

In 1998, an early New Labour discussion paper on joint working between health and social care set out a strongly worded critique of what happens when potential partners fail to work together effectively. Although this is now dated, we quote this diagnosis of the problems to be solved on a regular basis, as it seems to us to so accurately reflect the practice realities that we observed at the time and the negative impacts that can still occur when frontline agencies fail to collaborate: