Chris Ham, Chief Executive at The King’s Fund, gives an introduction to the Health and Social Care Act with a particular focus on integration. He explains what is meant by integration, looks at good practice case studies and outlines the duties of Monitor, the NHS Commissioning Board, clinical commissioning groups and health and wellbeing boards.

1. Health and Social Care
Act and Integration
Chris Ham
Chief Executive
The King’s Fund
15 November 2012

2. Duties in the Act to promote integration
Monitor
‘The main duty of Monitor in exercising its functions is to
protect and promote the interests of people who use
health care services…’
‘Monitor must exercise its functions with a view to preventing
anti-competitive behaviour in the provision of health care
services…’
‘Monitor must exercise its functions with a view to enabling
health care services provided for the purposes of the
NHS to be provided in an integrated way...’
‘Monitor must exercise its functions with a view to enabling
the provision of health care services provided for the
purposes of the NHS to be integrated with the provision
of health-related services or social care services...’

3. Duties in the Act to promote integration
NHS Commissioning Board
‘The Board must exercise its functions with a view to
securing that health services are provided in an
integrated way…’
‘The Board must exercise its functions with a view to
securing that the provision of health services is
integrated with the provision of health-related services
or social care services…’
‘The Board must encourage clinical commissioning
groups to enter into arrangements with local
authorities in pursuance of regulations under section 75
where it considers that this would secure –
(a) that health services are provided in an integrated way…
(b) that the provision of health services is integrated with the
provision of health-related services or social care services…’

4. Duties in the Act to promote integration
Clinical Commissioning Groups
‘Each clinical commissioning group must exercise its
functions with a view to securing that health services are
provided in an integrated way…’
‘Each clinical commissioning group must exercise its
functions with a view to securing that the provision of
health services is integrated with the provision of
health-related services or social care services…’

5. Duties in Act to promote integration
Health and Wellbeing Boards
‘A Health and Wellbeing Board must, for the purpose of advancing
the health and wellbeing of the people in its area, encourage
persons who arrange for the provision of any health or
social care services in that area to work in an integrated
manner.’
‘A Health and Wellbeing Board must, in particular, provide such
advice, assistance or other support as it thinks appropriate for
the purpose of encouraging the making of arrangements
under section 75...’
‘A Health and Wellbeing Board may encourage persons who arrange
for the provision of any health-related services in its area to
work closely with the Health and Wellbeing Board.’
‘A Health and Wellbeing Board may encourage persons who arrange
for the provision of any health or social care services in its
area and persons who arrange for the provision of any
health-related services in its area to work closely together.’

6. Duties in draft Care and Support Bill to
promote integration
Local authorities
‘A local authority must exercise its functions under this Part
with a view to ensuring the integration of care and
support provision with health provision and health-
related provision…’

9. What is meant by integration?
Vertical integration between hospitals,
community services and social care
Horizontal integration between hospitals, or
between GP practices in networks
Real integration : mergers
Virtual integration : networks and alliances

10. Lessons about integration
Clinical and service integration usually deliver
more than organisational integration
Integration must be based on needs of patients
and people
The transformation of the Veterans Health
Administration (VA) in the US shows what can be
achieved
The VA cut use of hospital beds by over 50% and
improved quality and outcomes for patients
Its transformation was based on a burning
platform and strong leadership

11. Lessons (2)
Torbay has shown benefits of health and social
care integration for older people
Integrated community health and social care
teams aligned with GP practices
Pooled health and social care budgets used
flexibly to support people in the community
Reduced use of beds and delayed transfers of
care near zero

12. Next steps
› A decade of austerity in public services lies
ahead
› The test for local leaders could hardly be
greater
› The challenge is to maintain good operational
performance
› And to act strategically on developing
sustainable and high quality integrated services

13. In summary
› Organisations can focus on their own survival
or on working together to make necessary
improvements in care
› Whole system approaches require real effort
but are likely to offer greater benefits
› The management and regulation of the NHS
does not lend itself easily to whole system
approaches
› Policies on competition may get in the way of
collaboration and integration if applied in the
wrong way

14. Finally, the wrong kind of integration
Small scale pilots
Disease based
Too focused on organisational change
Monopolies that are unresponsive and inefficient
Competition and integration are not incompatible