Options for integrated commissioning Beyond Barker

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Part of Commission on the Future of Health and Social Care in England

With around 400 separate local organisations each responsible for commissioning different health and social care services, the current organisational landscape is fragmented and unsustainable. Support is growing for a new settlement based on a single ring-fenced budget and a single local commissioner – as recommended by the independent Commission on the Future of Health and Social Care in England, chaired by Kate Barker.

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.

Read our summary of this report

Key findings

  • 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.

Policy implications

  • 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.



Comment date
23 January 2017
Councils have the advantage of being free from the set of conflicts of interest that GPs might face

Jan clarke

Comment date
14 October 2015
Sexual health services should provide a painful example of what happens when local commissioning is not integrated - real damage to patient care, public health and clinical services is the result at present HWBs need much more statutory powers before they can act as a single responsible coordinator for co-commissioning in an area


Comment date
13 June 2015
Most HWBB have achieved stability and are now entering a cozy period. There is little demonstration of urgency, vision, energy. There is no hunger for the job given to them. There is a need for Ministerial action to kick butts and set targets for delivery of integration and outcomes. This is another polite cozy club run at tax payers expense. We must expect Government action as the evidence is compelling.

Pearl Baker

Carer/Independent Mental health Advocate and Advisor,
Independent Mental Health Advocate and Advisor
Comment date
12 June 2015
I agree that a single 'ring fenced' budget should be put into place, this should be managed by CCG, NOT LA. It is essential that those commissioned to implement 'integration' are fully informed of their responsibilities, this will require considerable 'reading' and understanding of the relevant Acts and Laws, including the MCA2005 code of practice, Personal Budgets. Carers rights under the Care Act 2014, and housing legislation, DWP/welfare, Guardianship, are just a few to mention.

To commission LTC you must first establish what 'budget' is required to deliver 'integration' , which will be different to each individual, based on need.

Carers involvement is essential if the CCG are to deliver Health and Social Care, we are willing to 'play our part' however we must be accepted and seen as integral part of the system if 'integration' is to be achieved.


Retired yes we do exist,
retired again
Comment date
11 June 2015
How can cooperation be reconciled with competition no wonder Other Providers are opposed- they want to continue to rip off the NHS,

Peter Palmer

Comment date
11 June 2015
I have doubted for some time that local authorities are the right people to administer social care.
The whole should come under the NHS to provide the required seamless care delivery.
Patient care planning must include co-morbidities. Under two masters the care will inevitably be negatively impacted.

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