Interfacing legitimacy - health and social care integration in Scotland.

Abstract

As people, particularly those ageing and living with disabilities, struggle with how care is enacted, integrated care has gained policy purchase in the United Kingdom. Despite integration's apparent popularity, its contribution to improved care for people has been questioned, exposing uncertainties about its associated benefits. Nonetheless, over decades a remarkably consistent approach to integrated care has advanced partnerships between the NHS and local government. Accordingly, in 2014 the Scottish Government mandated Health and Social Care Integration (HSCI) via the Scottish Public Bodies (Joint Working) (Scotland) Act. Emerging from an interorganisational ethnography of the implementation of a Health and Social Care Partnership in 2016, in a place I call 'Kintra', I interrogated what happened when NHS Kintra and Kintra Council endeavoured to implement HSCI according to the precepts of 'the Act'. Immersed in the everyday arrangements in the spaces of governance, I attended to how these policy actors worked to both (re)configure and held things together behind care frontiers, and away from the bodywork of direct care. I charted their efforts to comply with regulations, plan, and build governance apparatuses through documents. In following documents, I show the ways in which HSCI was materialised through documentation. I reveal how, in the mundane mattering of document manufacturing, possibilities for (re)forming the carescape emerged. I deploy a posthuman practice stance to show not only the way in which 'papery' partnerships between the NHS and local government 'enact' care, but also how they make worlds through a sociomaterial politics of anticipation.