Recommendations for integrated commissioning

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

It is now universally recognised that health and social care services need to be much better co-ordinated around the individual to ensure that the right care is offered at the right time and place.

In its final report, published in September 2014, the Commission on the Future of Health and Social Care in England called for an end to the historic division between health and social care. Its central recommendation was for ‘a single, ring-fenced budget for health and social care, with a single commissioner’.

The King’s Fund report, Options for integrated commissioning, builds on this work and presents recommendations to ensure that there is integrated commissioning in all parts of the country by 2020. A key challenge is to implement these arrangements without embarking on a top-down structural reorganisation.

A national outcomes framework for integrated care

A single national outcomes framework for integrated care should be agreed. This should describe what it is that local commissioning arrangements should achieve, not the ways in which to achieve them.

A requirement to integrate

Local authorities and clinical commmissioning groups (CCGs) should be able to demonstrate how those outcomes will be achieved for their local population through a single commissioning function and a single integrated budget. These arrangements should be in place by 2020 at the latest, with the organisational model developed and agreed locally from 2017.

Local decisions about how best to integrate

Recognising that there is no one-size-fits-all solution, CCGs and local authorities should agree locally how best to integrate commissioning, responsibilities and budgets.

The report offers three options for CCGs and local authorities to consider:

Option 1 – build on existing arrangements

Model for integrated commissioning

This option involves no significant changes to current structures. Health and social care funding would continue to be routed separately to CCGs and local authorities with an expectation that they reach local agreements on how to align funding and commission services.

  • No disruptive organisational change
  • Builds on local relationships being developed through Better Care Fund and Pioneer Programme
  • Depends on good relationships between local organisations
  • Could perpetuate poor co-ordination and fragmentation of care
  • Unlikely to deliver change at the scale and pace required

Option 2 – CCG or local authority takes the lead

Model for integrated commissioning

This option involves giving lead responsibility for all health and social care commissioning to the local authority or the CCG. The decision about which of the two should take the lead could be made at a national or a local level. 

  • Single local body with clear responsibility and accountability
  • Could trigger a battle between local government and NHS at a time when collaboration is vital
  • Would involve organisational change
  • Could result in very different arrangements across the country

Option 3 – a new vehicle: ‘health and wellbeing boards plus’?

Model for integrated commissioning

The report concludes that, in their current guise, most health and wellbeing boards are not yet ready to become the single commissioner. However, with some changes they could become the local executive decision-making body for the integrated budget.

  • Builds on existing role of health and wellbeing boards
  • Continuing role for local authorities and CCGs
  • Minimises organisational change
  • Similar arrangements being pursued in Greater Manchester and Scotland
  • Requires legislation to give the board adequate legal powers
  • Profound step-change for existing health and wellbeing boards; would require robust capability assessment

A combined budget for health care, social care and public health

Combined budget for health and social care

Finally, at a national level, spending on the NHS, social care and public health should be brought together in a single ring-fenced funding settlement. Responsibilities for social care funding should be transferred to the Department of Health which would then be responsible for agreeing how all the funding should be distributed to local areas.


The case for change in commissioning health and social care services is overwhelming – the current fragmentation of commissioning arrangements is not sustainable.

As the Commission on the Future of Health and Social Care in England acknowledged, ‘moving to a single budget with a single commissioner is not a sufficient condition to tackle the myriad problems that face health and social care. But we believe it is a necessary one.’

Forty years of successive attempts to achieve closer alignment between health and social care resources underline the scale of the challenge, but with widespread support for the goals of integrated care there has never been a better time to make this happen.