Councils need to build on their successes in integrated health care - Simon Morioka talks about fixing the gaps between shared objectives and separate structures in health and social care

posted 04 September 2013

Another week, and another report provides a reminder of how local government is changing. The report In Sickness and in Health from the independent thinktank Localis reflects the growing recognition of local government's role – working hand-in-hand with health commissioners, healthcare providers and local communities – in driving better health outcomes.

However, the report also recognises many of the difficulties faced by those responsible for making this work in practice. To understand the opportunities and the challenges involved, it is important to understand the broader context within which these changes are happening.

Well over a year since Barnet's "graph of doom", councils face a further round of budget cuts and council tax freezes. Meanwhile, as demands on local health and social services grow, so do questions about whether patients and service users are receiving the quality of care they deserve.

Not surprisingly, the mantra that only radical transformation will do has become the meme of public service reform, echoing around council chambers, conference halls and management boards. But talk to those at the frontline and there are few better places to start than the interfaces – or, perhaps more accurately, the gaps – around how care is delivered.

The concept of better co-ordinated services, centred on the needs of individuals, isn't new. The Local Government Association suggested that rolling out whole place community budgets could save between £9bn and £21bn over five years. The fund for joint NHS and local authority commissioning is set to be £3.8bn by 2015-16. And there is comfort in what one Localis researcher, Gwilym Tudor Jones, said earlier this year about the "near feverish excitement" around uniting health and social care services. But questions remain as to why it has taken so long already and what will happen next.

The story of health and social care in England is often written as one of crisis, but it's important to remember how much of this is driven by another story – one of success.

Between 2001-02 and 2011-12 net NHS expenditure increased from £49bn to £104bn.At the same time, gross expenditure on adult social care increased to £17bn, a 33% rise over the same period.

The benefit of bringing these services together is an area of almost complete political agreement. But the reality is that the closer we get to integration, the clearer both the opportunities and challenges become.

Take away considerations of politics and funding and we are still left with organisations with cultures, practices and infrastructure that are as separate as their objectives are shared.

Health and wellbeing boards will be crucial to fixing this, providing the one vital place where the right people come together with a view across the whole and the remit to make change.

This summer saw the launch of the Local Government Association's support for health and wellbeing boards seeking to integrate care at scale. Working with partners, including NHS England, Monitor, the Department of Health and Integrating Care, this is about providing practical help to identify opportunities, overcome barriers and implement the new models of working that promise the biggest improvements for service users and organisations alike.

At the heart of the association's work is the recognition that many local authorities and their partners have already made good progress in bringing together services. Learning from what has been achieved, and making it the norm, is our best chance of meeting the challenges ahead.

Simon Morioka is managing director at PPL and senior adviser at Integrating Care.

This article first appeared on the Guardian website