“Integration is going to be as important as competition”, health secretary Jeremy Hunt has declared.

It is a message ministers have sung ever since the word was crowbarred into the health reforms to calm fears over increased competition.

To date, very little has happened - apart from endless attempts to define the meaning of integration in the context of health and social care and a few brave attempts to drive change at a local level.

But now change is in the air. Poor integration between NHS services and with social care is perhaps the biggest cause of patient complaint. Mr Hunt says he wants quality of care to be as important of quality of treatment. Meanwhile, his Liberal Democrat junior Norman Lamb will be determined to ensure integration becomes more than a buzzword.

This week, HSJ reports the government may use the Care and Support Bill to drive the sharing of budgets between clinical commissioning groups and local authorities.

But there is another, complementary, plan doing the rounds in government circles. This involves a “whole city” pilot of full integration, with pooled budgets and all health and social care players expected to get involved. The lessons from this pilot would be used to guide the next round of service reform.

There is careful checking going on to make sure this approach is possible within the constraints of the new Health Act.

The current view is that it is, as long as the secondary legislation setting out Monitor’s obligations to ensure appropriate competition are drafted flexibly enough.

It will also be necessary to find an area where commissioners believe the pilot to be a good idea and to ensure the NHS Commissioning Board is bought into making it a success.

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