Opportunities outweigh threats in new white paper on health and social care integration

This is a framework which could enable real progress on integrating health and social care services
Health and social care integration plans "are no sticking plaster". Photo: Adobe and stock

By Andrew Hudson

18 Mar 2022

Two recent announcements have focused on aspects of joining up government. It is an important theme in the levelling up white paper, and – of more direct interest to me now – is at the heart of the white paper, Health and social care integration: joining up care for people, places and populations.  

My own experience – trying to make partnerships work in local government, setting frameworks in Whitehall, and writing about the accountability aspects more recently – underlines the familiar point that relationships matter more than structures, and that these take time to build. But there isn’t unlimited time to invest in getting to know each other, so there are certain things that central government, local leaders and regulators can do to help the process of building integrated services along. 

How does this look for the health and care white paper?

It’s a good start that the paper doesn’t pretend integration is a panacea for the major challenges of the shortage of staff in both health and care, and the shortage of funding in many areas. Sensibly, it has far fewer short term targets and bold promises than many such documents. Instead, its tone is mostly permissive, making “space for local leaders to agree shared outcomes that meet the particular needs of their communities, whilst also supporting national priorities”, and empowering them “to deliver against the agreed outcomes”.

To help maximise the opportunities, central government needs to stick to its word, and keep prescription to a minimum. It’s also important to keep both central and local targets stable: one of the main concerns from managers I spoke to for my earlier paper was changing lists of things to report, and different indicators for different bosses on different timescales. Central government can also support integration, and indeed good management all round, by providing its guidance and funding announcements – for both NHS and local government – in good time for local budget-setting. And it should eschew further structural change, even apparently minor – this is more likely to detract from progress on outcomes, when we should all be concentrating on bedding in the new integrated care systems.

Health and care leaders can take the white paper as a green light to get ahead with planning what works for each locality. It helps that the document is jointly published by the secretaries of state for health and care and for levelling up (which includes local government), and feels more like a genuinely shared agenda than some previous work on integration. There are plenty of examples of progress at local level – in City and Hackney, where I’m a non-executive director at Homerton Healthcare Trust, the trust CEO is also the place-based leader shaping joint work across the boroughs with primary care and the local authorities. The challenge for us all is finding headspace and resource, rather than needing permission.

"There has been a lot of focus on the white paper’s call for 'a single person, accountable for the delivery of the shared plan and outcomes for the place'. The radical simplification implied here is not possible"

Accountability for integrated services will always be complicated so long as we have different funding streams, with the NHS funded by the national taxpayer and social care by elected local authorities. There has been a lot of focus on the white paper’s call for “a single person, accountable for the delivery of the shared plan and outcomes for the place”. 

The radical simplification implied here is not possible, as the section goes straight on to say that this person “will be agreed by the relevant local authority or authorities and integrated care board” (my emphasis), and that the proposal will not change the current local democratic accountability or formal accountable officer duties within local authorities. 

So local leaders are bound to be accountable to at least two masters. But that is not unworkable. And more important, success will depend on that person building good relationships rather than pretending they can exercise command and control.

The final point for lasting success is that the government should commission proper evaluation of how the emerging arrangements are working. The proposals so far draw on some evidence from existing models, and continuous learning is important. But that is no substitute for a formal evaluation.

Overall, this is a framework which could enable real progress on integrated services. If central government and regulators stick to the streamlined and proportionate approach in the white paper, and local leaders show they can take advantage, patients and service users will see change for the better over time. 

Andrew Hudson is a former chief executive of the Valuation Office Agency and director general of public services at HM Treasury. He currently chairs the Centre for Homelessness Impact. This column was first published in CSW's March 2022 issue, which you can read in full here

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