This report explores the options for implementing that recommendation. It assesses evidence of past joint commissioning attempts, studies the current policy framework and local innovations in integrated budgets and commissioning, and considers which organisation is best place to take on the role of single local commissioner. The paper draws together findings from a body of work including a survey of existing joint arrangements, current evidence and examples, a seminar with pioneers of integration developments, and a national conference on integrated commissioning.
- A strong message from this work is that integration is not an end in itself but a means to better outcomes.
- Examples of fully integrated commissioning are limited, with the nature and success of joint arrangements varying significantly depending on the area.
- Many local organisations consider that health and wellbeing boards have the potential for a greater commissioning role but lack the skills and resources required. Local authorities were overall more positive about this potential than NHS partners
- Few health and wellbeing boards show readiness to provide a system leadership role, to take on executive decision-making over an integrated local budget, or to command the confidence of CCG partners.
- We feel that in their current guise, health and wellbeing boards are not yet ready to take on the role of single local commissioner.
- The starting point should be a single national outcomes framework for integrated care to achieve joint accountability between the NHS and local government. This should be implemented via a local integration programme drawn up between CCGs and local authorities.
- From 2017, local authorities and NHS partners should establish a single local commissioning function, with a single integrated budget. This should be in place everywhere by 2020 at the latest.
- National bodies should work with CCGs and local authorities to develop organisational templates, based on the options in this report, through which local arrangements can be made, including enacting the ‘health and wellbeing board plus’.
- A single integrated national health and care budget stream should be established in central government, making one department responsible for negotiating and implementing the spending review settlement.