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Introduction
Although it is widely agreed that integration is a crucial component of a high-quality health and social care system there is somewhat of a lack of evidence clearly demonstrating a link between integration and service user outcomes. Although there are many examples of good practice in this journal and other publications, there is a distinct lack of high-quality evidence in the research literature (e.g. [3] Cameron et al. , 2012). It has been noted that it is very difficult to evaluate joint working ([24] Sullivan, 2011). [21] Powell and Dowling (2006, p. 305) describe attempts at joint working in health and social care as "the indefinable in pursuit of the unachievable" as integration is rarely defined in terms of what it means precisely and it is often unclear just what kinds of outcomes they are aiming to achieve for service users ([7] Dickinson, 2008). Against this background a new experiment in policy and practice is taking place in England, where service users and third-sector organisations (TSOs) have worked with system leaders to create a common definition of "integrated care", which is intended to drive a new wave of integrated care programmes in every locality over the five years to 2018.
The distinctive aspect of this definition is that it is written from the point of view of patients, service users and carers. It sets out what will happen in their experience of care and support when a high standard of coordinated care is achieved. The definition sits within a "narrative" which was part of a package of commitments launched in London by a minister of state on 14 May 2013 ([6] Department of Health, 2013). It should be carefully watched to see whether it has any greater impact and significance than previous, piecemeal attempts to bring health services and social care services closer together.
This paper, written by the principal author of the "narrative", describes its content and explains the background to the initiative, the sources used and the method of its development. It also considers what factors may influence success, and offers some thoughts about the implications of this approach for other areas of health and social care policy and practice.
Background: the need for a narrative
Between the summer of 2011, when...