Chapter 5

Cultural differences

Among council chief executives, funding and cultural differences between local government and the health service loomed large. One chief simply answered that the biggest barrier was “the culture of the NHS leadership” while a second highlighted a “lack of cultural and geographical alignment”.  A third was even more succinct, writing the single word “funding”.

For another chief executive, financial challenges and workforce issues combined to create a broader barrier to successful integration – “system stress”.

Expanding on these themes, one chief executive answered: “Finance, different operating cultures, differing priorities... better central funding, honest and robust conversations as part of ICS and agreement and alignment on local priorities not central NHS targets.”

These concerns about the NHS were echoed by another chief: “The biggest barrier
is the top-down approach the NHS are taking in establishing the new ICS structures
(local government not properly represented or considered) and the removal of key people from our existing CCG (clinical commissioning group) who had established strong working relationships across the health and social care sector.”

Another chief executive who said the integration programme “all feels very NHS focused” raised concerns about “how provider collaboratives will link with places”.

"The biggest barrier is the top-down approach the NHS are taking in establishing the new ICS structures"

Chief Executive Respondent

They added that addressing this issue “will need real effort and conscious activity to ensure the ICP (integrated care partnership, whose role is to plan to meet wider health, public health and social care needs but which does not commission services) has influence equal to that of the ICB (integrated care board, which allocates NHS budget and commissions services) within each system”.

And for one assistant chief executive, barriers include the need for more investment in prevention from the government, the use of NHS money – “needs reform to NHS funding so stronger incentives to invest in community health and prevention rather than overly focused on acute capacity” – and a shift in the NHS’s focus: “Government/ NHS to be more focused on joining up culture/ behaviours that identify with the place rather than overly focused on national NHS.”

Finance officers had similar concerns to chief executives, with one citing “funding” and another highlighting “the different basis of funding for NHS and social care and governance”.