In a report looking at how the recommendations of the Barker commission to integrate commissioning could be achieved, the think-tank highlighted around 400 separate local organizations that were each responsible for commissioning different health and social care services.
This was both “fragmented and unsustainable”, the report said, and there was need for full integration to both improve provision for users and to get additional value for money.
As a first step, ministers create a single national outcomes framework for integrated health and care to act as a starting point to boost current integration schemes, such as the Better Care Fund, the report stated. Then local authorities and NHS partners should work from 2017 to establish a single local commissioning function, with a single integrated budget. This should be in place everywhere by 2020 at the latest.
This should be matched with a single integrated national health and care budget stream in Whitehall, with one department responsible for negotiating and implementing the spending review settlement.
However, the individual arrangements for integration should be agreed by the local authority and health organisations.
Four possible models were set out. There were health and wellbeing boards taking on the role – possibly after some reforms – CCGs becoming responsible, local authorities or an entirely different vehicle.
Although the report highlighted that many saw health and wellbeing boards as the obvious candidate to take on the role of a single commissioner, as they were established to promote integration, this view was not universal.
A survey of 33 health and social care commissioners found that enhanced HWBs were the most popular body to take on the role, but this did not include a single CCG polled. Conversely, 44% per cent of the CCGs responding to the question identified the CCG as the right body to take on the single health and care commissioner role, although no local authority agreed.
The difference in levels of support for the “health and wellbeing board in its current form” as a single commissioner (the least popular option) compared with the “health and wellbeing board, with changes” (the most popular option) also suggested they are not currently viewed as having the necessary skills and resources, the report concluded.
“This suggests that far more work would be needed to build the confidence that NHS organisations have in the potential of health and wellbeing boards to become a single commissioner,” it concluded.
