One system, two nations

Who It's For

Leaders in health, social care, housing and the voluntary sector working on integration in Wales and England

Overview

People experience care as one life, not a set of organisations. This first half of Joining up care begins with Walter Leutz's three levels, the rainbow model and the Welsh what matters conversation, then compares Regional Partnership Boards and A Healthier Wales with England's integrated care systems and the plan to abolish NHS England. The Senedd and the English NHS follow. It then lays foundations in systems thinking, from Donella Meadows and Peter Senge to stocks, flows and Seddon's failure demand, and maps it with Checkland and Ulrich. The final part turns to pooled budgets, the Better Care Fund and Regional Integration Fund, and Schein's levels of culture.

Aims

The ambition is to help leaders explain how integration works on both sides of the border, plan around functions rather than organisations while structures change, read recurring problems as patterns in the system, and test whether a pooled fund or joint workforce plan will genuinely deliver for people.

In summary, you will be able to:

1. 1Compare how Wales and England organise integration, from Regional Partnership Boards to integrated care systems and the 2025 to 2026 reforms.
2. 2Analyse a recurring problem, such as a waiting list, using stocks and flows, feedback loops and Ulrich's boundary questions.
3. 3Assess a pooled fund's purpose, governance, risk sharing and exit plan, and plan practical steps for a joint workforce.

What you'll develop

Across this Explore, you will develop the ability to:

1. 1Explain why integration is a means rather than an end, and use Leutz's three levels and the rainbow model to judge how much integration a group of people needs and where it has to happen.
2. 2Explain why Wales plans integration by region and how the Welsh model, in which health boards both plan and deliver care, shapes partnership and accountability.
3. 3Identify whether a policy area is devolved, reserved or partly devolved under the reserved powers model, and why that decides who you engage.
4. 4Explain the arm's length body model, how it differs from direct delivery, and the role of the Secretary of State's powers of direction.
5. 5Explain what a system is, using elements, interconnections, purpose and boundary, and distinguish tame problems from wicked ones.
6. 6Explain how stocks, flows, reinforcing and balancing loops and delays shape the behaviour of a public service system over time.
7. 7Explain why counting the whole before splitting the parts, and seeing whose budget benefits and how soon, changes partnership conversations about prevention.
8. 8Explain why an integration plan must also be a workforce plan, using the scale of adult social care vacancies and the four recurring pressures on multi-agency teams.