Clinical commissioning groups need to work with councils to increase the scale of joint commissioning arrangements, a key figure in the NHS Future Forum has told HSJ.
However, Geoff Alltimes, the co-lead of the forum’s integrated services work stream, said the architects of new joint commissioning arrangements would first need to overcome problems caused by the breakdown in previous relationships resulting from the health reforms.
Mr Alltimes spoke to HSJ in an interview marking his retirement as chief executive of Hammersmith and Fulham Council. His Future Forum report to ministers, due in December, is expected to influence a social care white paper scheduled for next April.
He said his personal view was that ways needed to be found of “supporting communities that want to go further, faster” in relation to joint commissioning, in order to support service integrations such as single assessments for recipients of care.
“I’d like to get to the position where the pot of money is seen as one pot of money,” he said of funding held by councils and health commissioners.
“We do need to do [joint commissioning] on a greater scale. It would be helpful if we’re doing that in lots of places. What wouldn’t be helpful is if we have more small scale pilots.”
Mr Alltimes did not fully endorse the Valencia model of integrated care, under consideration by Weston Area Health Trust in Somerset. Under the system, the regional government pays a fixed price per inhabitant for primary and secondary care.
“I see a lot of positives in that, but I’d like to see a model that has social care too,” he said.
He admitted that the integrated care plans in his borough had been hit by health secretary Andrew Lansley’s reforms. “We were at the cusp of bringing together all of our adult and social care commissioning. The change of government and the Lansley plan meant we had to rethink that a bit,” he said.
Mr Alltimes repeated his warning, made in his previous report for the Future Forum on public accountability and patient engagement, that the disbanding of primary care trusts would “unpick” existing integration across health and social care.
“I still have that worry for the same reason – the pace of change, the new transfer of responsibilities and the financial circumstances mean there’s a risk that things that are working in some places could be undermined by those changes,” he said. While people were trying to “create new ways” of ensuring integration, “time is short” when it came to applying them, he said.
Asked which area of the last Future Forum report required the most work by the government, he highlighted electronic communication and the sharing of records between GPs, community health services and social care. “There seem to have been more difficulties about achieving that than I believe should be the case,” he added.
Mr Alltimes said he would like the Future Forum to “nudge” the government towards a “commitment” to a set of principles around which local providers could build appropriate IT systems.