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Think tank outlines three routes to integration


9 June 2015

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Three ways for commissioners to integrate health and social care budgets have been set out in a report from The King’s Fund.

Three ways for commissioners to integrate health and social care budgets have been set out in a report from The King’s Fund.

Options for integrated commissioning was released today and suggests CCGs either build on existing organisational and policy arrangements, or either the CCG or local authority takes lead responsibility for all health and social care commissioning, or that health and wellbeing boards are adapted to take on this role.

Richard Humphries, assistant director of policyat the King’s Fund, who created the report with a King’s Fund health policy fellow Lillie Wenzel, said the reason behind the new report was due to “a national problem”.

“Last year we set up an independent commission chaired by Kate Barker to look at how you could bring the health and care system closer together, given that they’re funded and governed in completely different ways.

“Their centerpiece recommendation was that you need to have one single ring-fenced budget both for the NHS and care, and one local commissioner to implement it.

“So what we’ve done in our report today is just set out some ways that you could do that without plunging the NHS into yet another top-down reorganisation. And essentially we recommended that local authorities and CCGs locally should work out their own way of doing it, but should be required to have it in place by 2020 at the very latest,” he said.

The first option is to build on existing organisational and policy arrangements. The report states ‘This option would involve no significant nationally imposed changes to current structures, working instead with the grain of existing organisations and policy processes’.

Health and social care funding would continue to be routed separately to CCGs and local authorities with an expectation that they reach local agreement on how their separate funding streams should be aligned around agreed local priorities and needs, and how services should be commissioned, and by whom,’ it says.

The benefits of this option would be no disruptive organisational change, and better local relationships being developed through the Better Care Fund and Pioneer Programme. However, it depends on existing good relationships between local organisations, could lead to fragmentation and is unlikely to deliver change in the time frame.

The next option The King’s Fund suggests is that the CCG or local authority takes lead responsibility for all health and social care commissioning, meaning that single body has clear responsibility and accountability.

This could trigger a battle between local government and the NHS, would involve organisational change and could result in inconsistent arrangements across the country, the report points out.

The third option is that, after some changes, health and wellbeing boards could take on the role of single commissioner.  This would build on their existing role, minimise organisational change, and reflect current arrangements being pursued in Greater Manchester.

On the other hand, this would require legislation to give the board adequate legal powers, and would ‘require robust capability assessment’.

It advises that since ‘there is no one-size-fits-all solution, CCGs and local authorities should agree locally how best to integrate commissioning, responsibilities and budgets’.

Read the full report here

 

 

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