Simon Goacher, Partner and Head of Local Government, Weightmans, 31 May, 2017

What’s clear from this report is that there is an appetite in the worlds of both health and social care for greater integration to deliver a more joined-up care experience for users and to make more efficient use of resources.

What remains less clear is how this will be delivered in practice.

There is no indication that a top-down structural re-organisation to implement this way of working is on the agenda for government.

Instead, it is likely to be a question of different local authorities and NHS agencies around the country forming partnerships through arrangements such as alliance contracts or by establishing Accountable Care Organisations.

It’s important to sound a note of caution here. While both sides forming these partnerships will no doubt be committed to working collaboratively, the reality is that the new organisations will be under a great deal of budgetary pressure. Under these conditions, it can be very difficult to avoid a situation where neither party wants to take on the risks involved and relationships can become strained.

The answer is a commercial framework that means both parties share financial responsibility for the performance of the system as a whole and have clear jointly agreed incentives for improved performance and ensuring demand management.

The raison d’etre of public sector bodies is to deliver the best possible care to end users within the budgets available, and ‘commercial’ can sometimes feel like a dirty word.

However, the reality is that it is only by addressing the commercial realities of these new relationships that organisations are going to be able to maintain the ethos of being entirely patient-focused and prevent contractual difficulties from affecting the quality of service being delivered.

Ultimately, pooling budgets has the potential to do great things in terms of removing silos in the system. Robust frameworks that clarify the sharing of responsibilities are the key to unlocking these benefits.