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Sheffield plans to merge 'very substantial elements' of health and care budgets

Sheffield’s clinical commissioning group and city council have revealed plans to merge “very substantial elements of [their] health and social care budgets”.

The move would build on previous work, some of which were covered in an HSJ local briefing, to create joined up community care, reablement and children’s services teams, and small shared commissioning budgets.

Much more ambitious plans are detailed in an application submitted to the Department of Health this month to become an “integration pioneer”. Sites are due to be selected in September.

The submission says the city has existing service transformation plans covering adult health and social care, children’s services, and metal health and learning disabilities.

It said: “[Sheffield City Council and Sheffield CCG] intend to integrate relevant commissioning responsibilities, and associated governance and delivery arrangements, to support our transformation programmes to fully achieve their aims.” They will also consider housing and education.

The proposal said: “The degree to which we fully integrate budgets will depend on how much integration is necessary to align organisational and personal incentives so that everyone is working together.”

Officials are developing service, governance and budget proposals which they want to be approved by the CCG and council in the autumn. They propose a “long term arrangement, traversing planning and political cycles”.

Applicants for the pioneer programme are invited to request “flexibilities” from policy and law to help them.

Sheffield’s bit requests the ability to account [financially] over years” as opposed to annually, flexibility to apply discretion over when it is appropriate to tender for services, and when we commission from existing providers”, and to change contract models and payment mechanisms.

NHS Sheffield CCG chief officer Ian Atkinson told HSJ: “What the patient doesn’t see is that even when we talk, technological, contractual, governance and financial barriers make it difficult for us to operate with the seamless approach that we think is key to making the system work and to delivering the highest level of care and support.

“We have the commitment in Sheffield to achieve great things for our patients, it would be easier if we could have longer financial allocation periods, flexibility on contractual shapes, more joined up system success indicators across social and health care and some clear rules that do not shift financial risk to the health service in developing the integration fund.”

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