(Dis)integrated care systems: lessons from the 1974 NHS reorganisation in Morecambe Bay

The Health and Care Act 2022 affirmed the ‘primacy of place’ in the National Health Service (NHS) through major structural reforms replacing General Practitioner (GP) led Clinical Commissioning Groups (CCGs) with 42 Integrated Care Boards (ICBs). The intention behind the Act was to strengthen engagement between the NHS, local authorities, and other stakeholders in place-based systems providing collaborative, integrated health and social care services across organisational and financial boundaries. This reversed longstanding political commitment to competition. However, identical intentions – about facilitating consensus, cooperation and cost-effectiveness between health and social services – underpinned the first major reorganisation of the NHS in 1974. Drawing upon a unique central government file dedicated to the problems the reorganisation raised for South Westmorland, this paper explores the gap between neat structural reforms imagined by the centre and their messy realisation in the periphery, highlighting similar tensions in the present.