Unintended consequences? The impact of NHS reforms upon Torbay Care Trust

Torbay Care Trust has been widely promoted as an effective model of integrated health and social care, and yet the impact of reforms introduced by the previous and current governments has been to destabilise its partnership coherence and its organisational form. This paper seeks to explain why this is the case, highlighting the potentially damaging consequences for the local, currently productive, system of care; and to indicate the local adaptations necessary to maintain progress, which are seen as under continuing threat in the current financial environment.

This is a personal reflection by the chief executive of Torbay Care Trust, reviewing the documented progress made since 2005.

The model of partnership, collaboration and risk sharing carefully nurtured over 15 years in Torbay has been proven to be beneficial not only for local people, but for NHS financial and clinical performance generally, and for social care performance. This is now paradoxically being undermined by the more commercially‐minded policy approaches of Labour's Transforming Community Services programme and by the current NHS reforms. New tensions have arisen across the “health and social care divide”.

The current government is unequivocally committed to integrated care, and specifically to integrated health and social care. The Torbay experience gives insight firstly into the care and attention which may be needed by government to secure this over forthcoming years; and secondly to the way in which integrated commissioning will have to be conceived and organised in the new system, and how integrated services will have, in turn, to be commissioned, and operated.