Chapter 7

Achieving integration

Given the undoubted challenges, how will councils actually approach the integration of their adult social care functions with health?

One council chief executive probably spoke for many when they simply said: “Carefully!

Some respondents emphasised how they will be building on existing work.

The white paper cites Manchester as an example of how “devolution … allows local places to have more flexibility to integrate care around the needs of their local populations”.

Responding to the LGC survey, a senior officer from the region outlined the approach set out in the Our Healthier Manchester plan: “We have set up an integrated Manchester local care organisation that brings together community health and adult social care. We have a Manchester partnership board that drives integration through LA leader, CEX, hospital trust, mental health etc.

“Next phase includes a greater focus on neighbourhood working in the broadest sense and greater integration with children’s services.”

One chief executive said: “We have lots of integration at local level and will work on a bottom-up basis.” Another noted how since 2018 they have had a joint post of a “council exec director for integrated health and care”, and that “public health is also the accountable officer for the clinical commissioning group”.

A similar theme was reflected in the comments of a number of finance officers, with one saying they would “build on existing positive relationships”, and another noting
“we already have good integrated teams – the real issue is going to be managing the expectations that ICS throws up”.

The importance of relationships to delivering integration was stressed by one chief executive, who said their approach would involve “focusing on relationships and using them to focus on service users not organisational structures or processes”.

And the importance of place was clear from the comments of two more chiefs, one of whom said “we will be establishing a joint ‘place’ committee” while another highlighted “closer working between health and ourselves overseen by local place board”.

However, one finance officer acknowledged the difficulties – their comment when asked how they planned to carry out the integration was “not fully known yet”.

Comments on the white paper more generally threw up a range of frustrations.

For one assistant chief executive it was a “missed opportunity for tangible, practical
actions to support integration – high level points about shared outcomes are fine in theory but will not drive change”.

A public health official said it was “too prescriptive”, while a finance officer described it as “vague at best”.

From chief executives, comments ranged from disappointment that “there is nothing in the white paper about the key role of district councils, even though they are providers of most of the wider determinants of health such as housing and leisure”, to a call for “greater recognition of, and engagement with, local government to establish the new structures – the role of elected members appears to not be properly understood”.

But given the concerns that ran through so many of the survey responses, perhaps a finance officer summed up the conclusion of many in the sector: “The government have set an impossible task to health and local authorities.”