The Case for Change


The case for change, described below, demonstrates a clearly identified need – to improve health and wellbeing and reduce inequality – and summarises evidence which supports integration through an ICO as the appropriate next step for partners in Salford Together.

Key points

  • People in Salford have poorer health status and outcomes and use more acute hospital services than the national average. Our population have high rates of long term conditions and co-morbidities, reflected in a range of data indicating people face shorter and less healthy lives than the majority of people in England. There is also evidence of substantial inequality within Salford, such as life expectancy between the most and least healthy wards (which varies by 12 years for men and 8 years for women). The ageing of the population will amplify these issues.
  • Alongside this demographic challenge, like all economies, Salford faces significant financial challenges despite each organisation delivering sizeable cost improvement and efficiency programmes over recent years.
  • We have reviewed national and international evidence on integration in health and social care. Although research in this area is limited, there is great potential for integration to deliver improvements in people’s experience and outcomes, supporting the use our limited resources more effectively.
  • At a local level, we have engaged extensively with our professionals and partners. This has demonstrated an enthusiasm to build on our collective culture of innovation and improvement, as well as the positive experience of integrating health and social care for older people.
  • We describe anticipated benefits of an ICO from two perspectives – first for service users, carers and communities, and secondly for the health and care system. These are reflected in a set of improvement measures including targets for 2020.


Our triple challenge of poor health outcomes, demographic pressures and financial constraints mean we cannot leave the system as it is. Salford Together, as commissioners and providers, have a shared view that radical change is required and that greater integrated care provision is required, within a wider integrated care system. We have reviewed evidence on best practice in the UK and abroad and have reflected with our staff and partners on our local best practice.

We recommend that a new ICO is created as a key element of our system’s approach to address the challenges we collectively face in Salford.