Integrated Care Cannot Succeed Without Radical Changes To Commissioning

A new report from The King’s Fund argues that the fragmentation of commissioning is a major obstacle to integrating health and social care and improving outcomes for people.

Options for integrated commissioning: Beyond Barker follows on from the final report of the independent Commission on the Future of Health and Social Care in England (the Barker Commission), chaired by economist Kate Barker, which called for an end to the historic divide between the NHS and social care. It recommends that all areas of the country work towards having a single local commissioner and single budget for health and social care by 2020. This would be an essential step towards delivering the new settlement for health and social care outlined by the Barker Commission.

The report sets out the key principles that should drive these changes including:

• no top-down reorganisation – any changes in commissioning arrangements should be locally led, not managed as a top-down reorganisation
• one size does not fit all – there are different options for implementing integrated commissioning so local authorities and clinical commissioning groups (CCGs) should work together to choose the best approach for their area
• change must happen at scale and pace – areas that can move quickly should do so from 2017, and all areas should implement new arrangements by 2020.

The report was written following extensive stakeholder engagement and analyses evidence from previous joint commissioning initiatives. It identifies three main options for moving to a single commissioner and single budget:

• maintain current structures and develop local agreements, building on existing initiatives such as the Better Care Fund
• require areas to assign responsibility for commissioning to either the local authority or CCG
• revamp health and wellbeing boards so they have the membership, capacity and powers to take on the single commissioner role.

The report finds that all these options have advantages and disadvantages – all could work in some places but none could work everywhere. Rather than prescribe a single model, it therefore recommends the approach should be agreed locally by CCGs and local authorities, based on a clear national policy framework.

Richard Humphries, Assistant Director of Policy at The King’s Fund, and the lead author of the report said:

‘As the Barker Commission set out, the case for change is overwhelming. Commissioning is more fragmented than ever, at a time when the imperative is to integrate around the needs of an ageing population with a mixture of conditions that defy service boundaries. Forty years of attempting to align health and social care leave us under no illusion about the difficulty of the journey to integrated commissioning, but with a consensus on the necessity of in