The latest on integration


Here is CIPFA’s choice of links to the most useful recent material on integration:

Local Government Association - The Journey to Integration: Learning from the Seven Leading Localities (April 2016)

NHS England - Vanguard Programme - New Models of Care (June 2016)

NHS England - Integration Pioneers - People helping People, review of year 2 (Jan 2016)

ADASS, NHS Confed et al - Stepping up to the place - The key to successful health and care integration (June 2016)

CIPFA/HFMA glossary of terms for health and social care (PDF, 442 KB)

The latest case study of particular interest is in the current issue of Public Finance. The Head of Integrated Finance, David Northey, explains Plymouth’s radical approach in the first of a planned series of case studies which will look at integration in practice.

Among the potential barriers to integration, differing geographical boundaries, incompatible systems and the rules about what can and can’t be done all have the potential to scupper the best intentions. It’s encouraging to find, then, that such potential difficulties can be worked around - where there’s a will. Plymouth Council and the local CCG have set up an integrated finance system for wellbeing, covering a large range of services even though they cover different areas, have different accounting systems and cannot pool all of their budgets.

By using the pragmatic approach of aligning those funds (notably for acute services) which cannot legally be pooled, the Council and CCG were able to apply the mechanism ‘£ pooled + £ aligned = £ integrated’ to bring together a cradle-to-grave integrated fund covering a uniquely broad range of services: public health; leisure; housing; children’s services (including the dedicated schools grant); adult social care; primary care; community health; and acute provision. Rather than change the governance of either organisation, a Plymouth Integrated Commissioning Board has been set up to oversee all aspects of integrated work. 

The integrated fund is underpinned by an agreed financial framework and a risk sharing agreement. The framework sets out the scope of the fund, responsibilities and arrangements for dissolving the agreement, statutory reporting requirements, budget setting, risk sharing and performance management. System incompatibility is tackled by continuing to maintain two separate ledgers with journals between the two organisations to recharge fund activity with fully detailed analysis, leading to a formal monthly joint finance report, which is used by both organisations to report financial performance. 

Full details of Plymouth’s ingenious approach are available here.