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A shared vision for integrated health and social care

The Local Government Association’s (LGA’s) portfolio holder for community wellbeing, Cllr Izzi Seccombe, outlines the essential components to help deliver fully integrated health and social care by 2020.

Health and social care is in a period of uncertainty. It is now more important than ever for local government to work with our communities and our counterparts in the NHS to secure a future for health and social care. But in the midst of flux and change, one thing that is certain is that joining up services is essential to achieving better health and wellbeing outcomes.  

In every area of the country, adult social care and the NHS are working together to align or combine assessment, commissioning and provision of services. But it is true to say that in most areas, even after years of commitment and numerous initiatives to promote integration, it remains a marginal activity. The Better Care Fund (BCF) has been effective in ramping up local integration and transformation activity. While the LGA supports the BCF as a national initiative to drive integration, it still represents a small percentage of total public resources for health and social care. We need to go further and faster along the integration road to meet the huge demographic and financial challenges facing us. 

The LGA, alongside our partners the Association of Directors of Adult Social Services, NHS Clinical Commissioners and the NHS Confederation, have come together to develop our own shared vision – ‘Stepping up to the Place: the key to successful health and care integration’ – to describe what a fully integrated system should look like, based on what the evidence tells us. 

We call on national and local leaders to ensure that integration moves from the marginal to the main way of doing business. We also outline the essential components of fully integrated health and social care: shared commitments to transformation; shared accountability and leadership; and shared systems to underpin and take forward the commitments. 

Shared commitments 

The evidence from areas at the leading edge of integration suggests that the single most important factor in driving integration is a clear shared commitment of all local system leaders to improve health and wellbeing outcomes for citizens. 

This means changing our model of care to invest in a place-based prevention and early intervention model to reduce demand on acute services. It also means a joint commitment to identifying the totality of resources available, and committing to focusing them on the interventions that will have the greatest impact on population health. 

Shared leadership and accountability 

Leaders will need to rise above their organisational interests to pursue a shared agenda. This requires governance arrangements that are robust, effective and transparent, capable of navigating the many different footprints for commissioning and delivery. This is no easy task: while the NHS is accountable through CCGs and NHS England to Parliament, local councils are accountable to their communities. 

That said, in the three years since their creation, Health and Wellbeing Boards (HWBs) have made great strides in bringing together the clinical, managerial, political and community leadership to forge a shared purpose. Now they must go further in ensuring clear governance and accountability for integrated services. Many HWBs are already considering how to align themselves to sustainability and transformation plan footprints.  The key to this is to ensure that decision-making is by the right people at the right level. 

Shared systems 

There are many things we need to do to put this shared purpose into action. A common information and technology system is vital in forecasting demand, planning care and population segmentation to identify those most at risk. We also need long-term payment and commissioning aligned across all budgets, whether pooled or not, that focuses on outcomes rather than activity. We need to ensure that resources can flow around the system so that money saved by reducing A&E admissions and hospital stays can be reinvested in community support. And lastly, we need to invest in our workforce so that they have the skills and shared culture to provide the right care and support at the right time. 

This is a challenging task, but our study of seven areas demonstrates impressive results. For example, Northumberland has achieved a 36% reduction in emergency admissions. Torbay has halved the rate of growth of care costs, compared with the national average, and Tower Hamlets has seen double digit increases in a wide range of health and wellbeing outcomes. I am not understating the scale of the challenge facing us, especially if we are to achieve the Spending Review commitment to integrate health and social care by 2020. Local leaders need the support of national leaders and policymakers by giving them the freedom, flexibility and resources to develop a health and care system that is fit for the future.

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