Silos also lead to a lack of connection and synergy in relation to policy as well as funding. Much policy relating to older people is driven by health and social care - understandably - defining older people as vulnerable and dependent. This means that addressing other needs becomes more difficult

Again, Infornation and Process models are needed as an enrichment to Integrated Pathways models. Scalingup of good practices is just wishful thinking, no matter how good the practice is, unless pathways are accurately described. Funding lines must be connected (connecting the dots!), but pencil and paper won't do for modelling that connection. The EIP AHA scalingup model is hopelessly poor.

Note also "silos of silos". There is the integration if primary and secondary care silo of silos, which strengthens the medical side, but does not help in creating integrated pathways for health and social care. If we continue to say "health always first, and social as required" we are making a huge mistake.

Is this primarily a result of the fractured organisational structure that underpins health and care. Scotland has legal powers to drive integration but the cooperation of the different organisations is a long term issue that needs incremental models to achieve.

An enabler is the development of approaches to inter-organisation cooperation and the development of incentives that drive cooperation towards sustainable health and care and avoid perverse incentives that encourage gaming and optimisation within single organisations.

thanks for the interesting comments on the separation of health and social care, Patrik. I also integrated the comment on the organisational fragmentation, Stuart