Integration is a hot topic right now, but there are some potential consequences that are significant and yet rarely discussed.

One of the consequences of the general election is that health and social care integration has become just another vessel in the fleet of policies to improve the country’s wellbeing, rather than its flagship.

Even though Labour shadow health secretary Andy Burnham had to row back on his original plans to merge health and social care budgets, he remained convinced he should try and bring the NHS on home to local government control.

Indeed, one of the most intriguing prospects of Mr Burnham becoming the head of his party would be a Labour leader who believes in the Herbert Morrison, rather than the Aneurin Bevan, model of healthcare organisation.

But the world looks different today.

‘The government is keen for CCGs to “own” the problem flowing from social care cuts’

NHS England chief executive Simon Stevens made it clear in his speech to the Local Government Association that integration projects must demonstrate benefits over and above those of aligning decision making processes and creating joint budgets. Few existing proposals would meet the criteria he set out.

Equally, in the government’s eyes the proposed devolution of powers to local government led by Greater Manchester are much more about attempting to stimulate economic growth in struggling parts of England.

Finally, although many in local government remain keen on integration, senior figures are also beginning to warn of the dangers. Departing LGA chief executive Carolyn Downs told our sister title Local Government Chronicle: “Local government will need to be extremely careful that it can afford to take on any additional risk.”

But it would be foolish to think integration will not impact on the NHS.

The consequences

Following are five of most significant, but little discussed, potential consequences:

  1. As HSJ commented last week, in the context of the service’s financial difficulties partly caused by delayed discharge, the government is very keen for clinical commissioning groups to “own” the problem flowing from social care cuts. While the jury remains out on the better care fund, among some influential figures it provides a vehicle to force that case.
  2. The introduction of personal health budgets was identified by Mr Stevens as one of three “routes” to integration. Local government’s familiarity with personal budgets gives him an opportunity to press forward with one of his favourite policies despite NHS reservations.
  3. Closer alignment between the NHS and local authorities is likely to be most sharply felt when councils take over commissioning powers from CCGs, either by agreement or because the groups are not perceived to be up to scratch. CCG performance metrics are in the pipeline and the government already has eyes on parts of the country where higher performing local authorities would take over from struggling and over-numerous CCGs. Undertaking this change in the context of an “integration drive” provides a useful narrative with any likely objectors.
  4. Integration will provide a mechanism for regions to operate as a “single NHS entity” across primary, community and secondary care. By far the most interesting aspect of the Manchester proposals for the NHS are developing plans on issues such as priority setting that could have profound impact elsewhere.
  5. Getting hospital clinicians into the community is one of the defining characteristics of this period of reform - crucial to delivering desired improvements in efficiency and outcomes. The least talked about vanguard programme is the “enhanced health in care homes” initiative, which seeks to give residents access to geriatricians and other healthcare professionals. It is the aspect of the NHS Five Year Forward View that could produce the earliest real world results - and it would happen in a service largely funded by local government without the need for NHS structural reform.