The LGA welcomes the values underpinning the white paper, and its ambition and scope, putting people and communities at the centre of integration policy to ensure that everyone gets the right care in the right place at the right time to achieve better health and care outcomes.
The LGA has long argued that integration is not an end in itself but a means of achieving better health and wellbeing outcomes for individuals and communities. We welcome the recognition in the white paper that this is the primary purpose of integration.
Achieving the scale of ambition set out in the White Paper will require substantial and long term commitment not only from Government but from local government and NHS leaders at every level. We look forward to seeing this reflected as the ICS and wider reforms are rolled out in practice.
We welcome the focus on prevention, but intent and ambition needs to be matched with adequate investment. Councils’ public health grant has been cut by 24 per cent on a real-terms per capita basis since 2015/16. In our Spending Review submission, we called for £1 billion of funding in 2022/23 rising to £3 billion in 2024/25 for a new Community Investment Fund, with much of the funding likely to be directed through the voluntary and community sector.
The white paper sets out a clear expectation of close collaborative and inclusive working between ICSs and places, in which systems and places, and the NHS and local government have parity. The focus on place is a welcome counterbalance to the recent focus on the role of ICSs.
We support proposals for a simplified national outcomes framework which allows place and system leaders to identify their own priorities. We also welcome the expectation that all places will work collaboratively to develop their and drive forward their own outcome plans.
Shared place outcome plans should build on and enhance existing place-based plans to improve services and population health outcomes. Place-based health and wellbeing boards already have key statutory duties to develop joint strategic needs assessments and joint health and wellbeing strategies. In areas where the HWB and the ICS share a footprint, there is a strong case for the existing joint health and wellbeing strategy to be revised and refreshed to form the shared outcomes plan.
With regard to a single accountable officer, it will be important for local government and the NHS to agree arrangements based on what is locally appropriate. In many places, they may wish to consider joint appointments to this role.
In determining place boundaries, ICSs should build on the boundaries of councils that have health and wellbeing boards, rather than creating new footprints that do not align with existing arrangements, unless there is local agreement to do otherwise . Many of the existing organisations, plans and partnerships – health and wellbeing boards, joint strategic needs assessments, joint health and wellbeing strategies, voluntary and community groups - are organised on the basis of local authority boundaries.
The paper takes a holistic approach to care and support, for example recognising the role of housing in supporting people to maintain healthy independent living. However, given the focus on the role of housing in the adult social care white paper, it is somewhat disappointing that there are relatively few references to housing as key component of integrated care and support in the integration white paper.
The proposals for strengthening the levers of integration – leadership and accountability, financial frameworks, digital technology and data sharing, and workforce planning and development – are ambitious and will require major investment and support from national partners. The LGA will continue to work closely with Government to support place leaders to drive the integration agenda. We will also work with Government to identify the resources and support needed for effective integration at place, and for joint working between place and system.
The LGA is working with the CQC and other stakeholders to develop the oversight and assurance framework for ICSs, as well as the assurance framework for adult social care. We will continue to make the case that ICSs will need to demonstrate, not only that they work collaboratively and inclusively with place based leaders but that they also operate on the principle of subsidiarity to ensure that decisions are taken at the most local level appropriate. With two parallel assurance processes in development, it is important that the right links are made between the two, including consideration of how the functioning of one may impact the other.