This document discusses the changing landscape for integration between the NHS and social care in England. It outlines the new legislative, fiscal, and ideological contexts, including the creation of clinical commissioning groups, health and wellbeing boards, and increased competition in the healthcare system. It questions how compatible competition and collaboration are and whether these changes will facilitate deeper integration or more tactical partnerships between organizations.

1. INTEGRATION and the HSCA 2012
‘THE TIMES THEY ARE A CHANGIN’
Professor Bob Hudson

2. The ‘OLD’ PARTNERSHIP AGENDA
• Joint Finance and long-stay hospital closures
• Joint commissioning between PCTs and ASC
• Integrated front-line teams
• Health Act Flexibilities
• Care Trusts ∂
• Messages on ‘a good partnership’
• ‘Readiness Tools’/partnership checklists
• Policy exhortation
• Political rhetoric

3. Secretary of state
NHS Outcomes Framework Public Health Outcomes framework Adult Social Care Outcomes Framework
NHSB with 4 regions and NICE
27 LATs Public CQC Health Watch EnglandMonitor Office of Fair
Health Trading
England
Commissioning outcomes framework
Local Health Watch
National and Regional Specialist Commissioning Public
Health
212 Health & WellbeingLocal
Boards Foundation
Clinical Commissioning groups ∂ Authority
Trusts
23 Commissioning Support Services
JSNA + Joint
Health and
Wellbeing
Strategy
Independent sector
Patients carers and the public
3 3

4. A CHANGING PARTNERSHIP LANDSCAPE
• NHSCB with regional and ‘local’ outposts
• Clinical Commissioning Groups
• Monitor
• Commissioning Support Units
• ∂
Miscellaneous creations: clinical senates/networks;
quality surveillance groups; NHS Commissioning
Assembly; HealthWatch etc
• Private companies, especially in CHS
• Enduring features: acute trusts and LAs – but both in
a new and evolving context

5. NEW ‘ARRANGEMENTS’
• National Quality Standards
• NHS Outcomes Framework/COF
• Public Health Outcomes Framework
• Public Health in Local Government
• ASC Outcomes Framework ∂
• Joint Strategic Needs Assessments
• Joint Health and Wellbeing Boards
• Joint Health and Wellbeing Strategies
• Will the outcomes frameworks drive integration?
• Do the JHWBs have partnering teeth?

6. The NEW LEGISLATIVE CONTEXT
• A cornucopia of new partnership duties
• Obligations on the NHS Commissioning Board
• Obligations on Clinical Commissioning Groups
• Obligations on Monitor
∂
• Obligations on Health and Wellbeing Boards
• Emerging obligations on Local Authorities in the Care
and Support Bill

7. The NEW FISCAL CONTEXT
• The ‘Nicholson Challenge’ – £20b by 2014 and
beyond
• LAs facing unprecedented cuts in budgets
• Funding shortfall in ASC and Dilnot funding gap
∂
• CHS under increasing pressure and uncertain future
• Acute providers facing increased demand, tariff
manipulation and threat of ‘market failure’
• Will this be a lever for ‘deeper’ partnering or ‘tactical’
partnering?

8. The NEW IDEOLOGICAL CONTEXT
• New powerful role for Monitor in ‘preventing anti-
competitive behaviour’…
• …and for promoting integration
• Embedding of UK/EU competition law into the NHS
∂
• Any Qualified Provider – first tranches well underway
• How compatible are competition and collaboration?
• If not easily compatible, what will the ‘trade-off’ look
like?

9. NEW and EMERGING MODELS
• Individuals as commissioners (PHBs/patient choice)
• New commissioning partnerships
• New provider partnerships
• Year of Care funding models
• ∂
Financial incentives to work jointly on ICPs
• Alternative Quality Contract/Accountable Care
Organisations
• Moving towards HMOs?

10. WHERE DOES THIS ALL LEAVE INTEGRATION?
• Balancing of the competitive and collaborative
imperatives is unclear
• Emerging evidence of ‘disintegration’
∂
• Lack of clarity over ‘system leadership’
• The threat of ‘repeal’…
• And replacement of HSCA by…
• Yes… ‘Integration’..