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Who is best placed to lead the integration of public services?

As public services seek to become more joined up, who is best-placed to take the ‘integration leadership’ role? In an article published in the MJ, MV’s John Copps looks at the case for local authorities, the NHS and housing providers, and what we can learn from devolution in Greater Manchester.

NHS England has recently announced plans for a consultation on the contracting arrangements for Accountable Care Organisations, the model that it hopes offers a route to more integrated health and social care services.

Integration is the mot du jour in public services. From combined authorities to STP footprints, political momentum and financial realities mean that public servants are being encouraged to work together.

Integration is a response to what we’ve known for a long time: people’s needs don’t fit into neat institutional and professional pigeonholes, and too much is lost in the gaps between services. Everyone agrees that more joined up public services are a good thing. But how we go about it in practice is the challenge.

A key question here is who or what sits at the centre of public services, in the ‘integration leadership’ role? Depending on who you talk to, you’ll get a different view.

Local authorities think they are the natural choice. They argue that their responsibility for ‘place’, jurisdiction over a wide suite of services, and accountability to the public through elected politicians mean that they hold the trump cards.

For the big expense of social care and health, the NHS is in the box-seat. The Five Year Forward View and Sustainability and Transformation Plans (STPs) arguably provides a clear mandate to lead. The way STPs have been conceived and developed reinforces the position of NHS organisations in the leadership roles – only four of the 44 STPs are led by local authorities.

Housing providers also stake a claim to be at the centre. The emergence of the ‘Housing First’ model, which places a decent and stable home at the core of people’s lives, offers a platform from which all other services can be coordinated and delivered. The model, developed in the US, is being piloted in England by the charity Homeless Link and explored by a number of councils.

So, given these claims, who is best placed to take on integration leadership?

Nowhere is thinking more advanced on integration than in Manchester, a city with a vision of ‘one system, one budget’. Jon Rouse, Chief Officer of GM Health and Social Care Partnership, describes an ambitious vision that is not limited to health and social care but involves ‘a journey of much wider and deeper public service reform’. At its heart, this reform is about improving citizens’ lives and having an impact on the determinants of wellbeing that affect all public services. This includes physical activity, social welfare and occupational health, alongside NHS and local authority social care services.

To make this system work coherently, integration leadership is one of the key issues Greater Manchester has to wrestle with. Its plan is to establish a set of ‘local care organisations’ in each of the city’s ten localities, whose role is to coordinate a wide suite of services. Who is best placed for this leadership role depends on circumstance – in some areas it is the NHS trust and others it is the local council.

The approach taken in Greater Manchester may end up as the blueprint for elsewhere in the UK. So far, one of the clear lessons is that what works in one area isn’t the same as what works in another. Local circumstance dictates the best fit solution, and is driven by capacity and skills, politics and personality. Other areas with ambitions for more integrated services should take heed.

To learn more about our work on integration or to find out how we can help you, contact John Copps