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GMHSC laments ‘limited’ integrated organisation forms and floats new care trust vehicle

Beyond short-term funding arrangements and traditional organisational boundaries, there are other systemic barriers that hold back the pace of health and social care integration – including a limited option of integrated organisational forms, outdated incentives schemes and technical workforce impediments.

These are the views of the Greater Manchester Health and Social Care Partnership (GMHSCP), outlined as part of its recent submission to an ongoing Public Accounts Committee investigation.

In an evidence document, GMHSCP agreed with all of the findings in a recent National Audit Office report, placing particular emphasis on issues around future funding and the traditional boundaries that exist between— and within— the NHS and local government.

The devolved partnership said that this leads to services being managed and regulated at the organisation level, which “remains a major challenge and leads to a number of perverse incentives in local systems.”

“Whilst we welcome, for example, the CQC’s recent review of health and social care systems, we believe there would be benefit in codifying a system approach to assurance and regulation in legislation,” the document explained.

But beyond these issues – which have been emphasised time and time again – the GMHSCP said that there are other barriers at play.

Importantly, it highlighted the currently limited amount of integrated organisational forms. The region’s local care organisations are currently operating as alliances of providers, but when they move to consideration of organisational form, there aren’t many options available.

“Whilst integration into an existing foundation trust can be the best option, we would welcome exploration of alternatives at national level. This could include, for example, a new Integrated Care Trust vehicle – although we recognise that this may require further legislation,” its committee submission said.

Elsewhere, the organisation highlighted national rules on CCG-retained surpluses, and incentive schemes such as CQUIN and QoF are still being designed through an individual organisational lens rather than through one of an integrated system. There are also “significant technical impediments” to staff moving between local authorities and the NHS and vice versa, especially to do with VAT and pensions.

Funding-wise, GMHSCP asked for clarity on a long-term capital pipeline for health and care in order to facilitate, amongst other things, greater long-term investment in digital infrastructure to accelerate integration.

Nationally, it recommended that the government and other national bodies apply reporting requirements. “Our reflection as a devolved system is that such requirements are too frequently focused on the individual organisation rather than adopting a genuinely place-based approach,” the body said.

“Further, reporting arrangements often lack flexibility and are not agile enough to reduce the burden on systems reaching advanced levels of maturity. We would cite the Better Care Fund as an example of a reporting system that displays these characteristics.”


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