Our health, our care, our say emphasised the importance of partnership working between NHS bodies and local government to achieve joined up service delivery tailored to the needs of citizens, for example by aligning the planning and budgetary cycles between local government and health. Partnerships are also core to the aims set out in the Local Government White Paper Strong and prosperous communities, which further strengthened partnership working by proposing:

• A duty for local authorities to prepare a Local Area Agreement, with agreed priorities, in consultation with others (including PCTs, NHS Health Trusts, and NHS Foundation Trusts).
• Formal arrangements for Directors of Public Health to be jointly appointed and held jointly accountable by the chief executives of local authorities and PCTs. Plus the encouragement of wider use of joint appointments of senior managers between local authorities and NHS bodies.
• A new statutory partnership for health and wellbeing under the Local Strategic Partnership. Legislation will propose a new duty to cooperate for PCTs and local authorities, in order to enable local partners to achieve a truly integrated approach to delivering local government and NHS priorities.

The Local Government White Paper gives a clear signal of the role for local authorities to be 'place shapers' and strategic leaders for their community: to develop a vision for their area and work to make it happen imaginatively and jointly. The purpose and focus of place shaping is on making localities better places in which to live and work.

Creating Strong, Safe and Prosperous Communities is a consultation document which provides guidance to local authorities and their partners specifically relating to new legislation introduced in the Local Government and Public Involvement in Health Act 2007. The guidance covers Local Strategic Partnerships, Sustainable Community Strategies, the new duty to involve, Local Area Agreements, the revised best value regime and commissioning.

Local Area Agreements (LAA)

Local authorities were already under a duty to prepare a Sustainable Community Strategy which sets the strategic vision for an area. The Local Government White Paper, however, now requires local authorities, in consultation with local partners, to prepare a single delivery plan for that strategy - known as a Local Area Agreement. The LAA will include a single set of targets for improvement, tailored to local needs, agreed between Government and local partners. Delivery of local priorities will be the responsibility of partners in key local partnerships like the Crime and Disorder Reduction Partnership, the Children’s Trust and the new Health and Wellbeing Partnerships. Once agreed with Government, local partners will be required to have regard to these priorities for improvement.

Health Act flexibilities

The Health Act (1999) introduced new powers to enable health and local authority partners to work together more effectively. Section 31 detailed partnership arrangements for health organisations and local authorities to:

• Pool funds - the ability for partners each to contribute agreed funds to a single pot, to be spent on agreed projects for designated services.
• Lead commissioning - the partners can agree to delegate commissioning of a service to one lead organisation.
• Integrated provision - the partners can join together their staff, resources, and management structures to integrate the provision of a service from managerial level to the front line.

North West case studies

• Knowsley Metropolitan Borough Council and PCT have established a Health and Social Care Commissioning Board to ensure that commissioning decisions improve quality, accessibility and effectiveness of services in the Borough. Find out more about Knowsley’s joint commissioning arrangements.

Sources of further help

Where next for health and social care integration?  NHS Confederation / Association of Directors of Adult Social Services Discussion paper  (June 2010)  Both the NHS Confederation and the Association of Directors of Adult Social Services (ADASS) have compiled a paper about the issues involved in the commissioning of integrated health and social care services to promote productive discussions in key stakeholder organisations.  It stresses the importance of good local relationships and joint strategies to the success of integration; it also looks at different models of integration and potential barriers to integration.

‘Only a footstep away’?: neighbourhoods, social capital and their place in the ‘big society’.  A skills for care workforce development background paper (June 2010) This
Skills for Care  paper looks at how local communities can support service users and carers in their community to contribute to the ‘big society’. The report explores how Skills for Care and other key stakeholders can build upon the skills of local people in communities to help them contribute to adult social care outcomes by helping vulnerable people in their communities.  The report contains a review of the literature around community skills and leadership approaches.

State of the adult social care workforce in England, 2010.  Skills for Care Skills for Care research report into the social care workforce in England.  The report provides useful statistics about the adult social care workforce.  The report statistics have derived from an improved data set; Skills for Care’s National Minimum Data Set for Social Care and national statistics from the Office of National Statistics.

Involving service users in shaping local services Joseph Rowntree Foundation (JRF) A new study looking at service user engagement. The study brought together a group of London commissioners and service users and discussed with them how they could be involved in shaping local services. The project reflected on current practice and considers how it can be improved in the future.

Total Place: Spend Counting Analysis and Customer Insight Status Department of Communities and Local Government (DCLG) (April 2010). Research on the spend and customer insight elements of thirteen Total Place pilots in England.  The research shows the strengths and weaknesses of spend counting and customer insight and providing recommendations for action in Central Government and at a local level.

Total Place: A whole area approach to public services HM Treasury and DCLG (March 2010). An initiative that was launched at the 2009 Budget as a key recommendation of the Operational Efficiency Programme.  It sets out new freedoms to encourage local leadership and better collaborative working to deliver better outcomes and value for money.  It introduces a reduction in central performance and financial controls and delivers new freedoms enabling places to collaborate better, to invest in prevention and to drive growth and inclusion.

Making Policy Count: Developing Indicators for Health and Social Care Partnerships: Position Paper This Department of Health paper updates the current work developing new performance indicators for adult social care, and health and care partnerships, setting the context and demonstrating recent progress.  It asks for stakeholder engagement by requesting comments and feedback and offers to pilot work (December 2009)

Creating Strong, Safe and Prosperous Communities: Statutory Guidance for local authorities and their partners covers the duty to involve and duties around Local Area Agreements in the Local Government and Public Involvement in Health Act 2007. It also replaces previous guidance on Local Strategic Partnerships ad Sustainable Community Strategies. Taken together, this document is a comprehensive guide to local authorities and their partners on how to engage their citizens, lead their communities, and find new and more effective ways to deliver high quality services.

Delivering Health and Well-being in Partnership: The crucial role of the new local performance framework, provides information about how the new local performance framework for local authorities working alone or in partnership will operate to drive improved outcomes in health and social care for local areas.

The Audit Commission offers downloadable reports and interactive toolkits, including Governing Partnerships: Bridging the Accountability Gap (October 2005), which urges local public bodies to take a much harder look at whether the partnerships they are involved in are delivering.

The Department for Communities and Local Government (DCLG) website at http://www.communities.gov.uk/corporate/ offers a range of information and advice, plus links to related websites, concerning local strategic partnerships. Other downloadable publications include:

• National Improvement and Efficiency Strategy (January 2008) sets out how central and local government will provide the support that local partnerships will need to deliver excellent Local Area Agreements.
• Local Strategic Partnerships: Shaping their future - A Consultation Paper.
• Local Strategic Partnerships: Shaping their future - An Analysis of Consultation Reponses (October 2006).
• Service Transformation Through Partnership (2006), a summary document and CD ROM toolkit that explains the benefits of service delivery partnerships with the public, private or voluntary sectors.
• Funding Partnerships: Making it Easier and Less Costly (July 2006).
• Evaluation of Local Strategic Partnerships: Final Report (January 2006)

Published by Communities and Local Government, Towards Lifetime Neighbourhoods: Designing sustainable communities for all explores how a more age-friendly vision of public spaces and community could boost social engagement, good health and the chances of 'active ageing' for all. The report explores how the built environment could offer a more accessible, inclusive space for the frail or disabled, but looks further into what role services, amenities, social cohesion and sense of place play in the creation of 'lifetime neighbourhoods', and how they might interact to create communities that maximise health, wellbeing and social engagement.

Commissioning Housing Support for Health and Wellbeing is a report commissioned by the Integrated Care Network which explains what housing related support services are and the funding streams and national programmes they sit within. The role of housing related support in reducing the need for more costly services and meeting shared performance goals between health and local government is illustrated. The purpose of this report is to help commissioners in health, local government and other public services to:

• Increase the positive impact of commissioning on the health and wellbeing of their local populations by addressing housing support in their strategies;
• Most effectively meet relevant Public Service Agreement (PSA)targets by building on existing expertise and systems;    
• Increase joint working between health and local government and other sectors to achieve better services. August 2008.

Delivering Care Closer to Home: Delivering the Challenge, published by the Department of Health, is a resource for commissioners and others interested in shifting care closer to home. It aims to share local emerging practice, how national enablers can support shifting care, and highlights new products developed to support local commissioners and providers. 9 July 2008.

The Department of Health website at www.dh.gov.uk has pages on partnerships and working with stakeholders. Publications include Making Partnerships Work: Examples of Good Practice (March 2007) which focuses on the role of third sector organisations as providers within health and adult social care. The Department also has a specific section on NHS Act 2006 partnership arrangements.

The Employers Organisation at www.lgpartnerships.com offers pages on Making the Most of Partnership Working, Partnership Health Check, Digging Deeper (reviewing your partnerships), Developing Skills for Partnership Working, and Resource including case studies and partnership tools.

The Health Services Management Centre at Birmingham University www.hsmc.bham.ac.uk specializes in development, education and research in health and social care services. Recent publications include: Creating NHS Local: a new relationship between PCTs and local government.

The Improvement and Development Agency (I&DeA) www.idea-knowledge.gov.uk has a section on Local Strategic Partnerships and Local Area Agreements (LAAs), which includes the LAA Toolkit and hosts the Local Agreements Network. IDeA also host the Making Ends Meet website which has 6 modules, one of which is about partnership and integrated services.

The Improvement Network at www.improvementnetwork.gov.uk is a partnership between the Audit Commission, IDeA, CIPFA, and the Leadership Centre for Local Government. Its partnership pages offer some information and tools for local authority managers, including 10 problems to watch out for.

The Integrated Care Network (ICN) www.integratedcarenetwork.gov.uk provides advice and information relating to the realities of joint working, with particular reference to health and social care. Their library offers the Support Materials Resource - Partnership Assessment Tool (Leeds Nuffield Institute for Health), which aims to provide a simple, quick and cost-effective way of assessing the effectiveness of partnership working. Recent accessible publications include:

• Integration and older people - A briefing paper for the Integrated Care Network. (October 2009) This briefing addresses some key developments in relation to older people and aims to raise awareness amongst commissioners and providers about the factors influencing integration and the benefits it can bring.  It is one in a series of three new briefings on integration from the ICN.  The others are on Mental Health and Learning Disability and are all on the ICN website.
• Adult Joint Ventures: Aspirations, Challenges and Options. (March 2007) covers partnership working and contestability in service provision, commissioning and procurement, and the ‘new localism’ or the ability of local government to take responsibility for the well-being of an area and to promote the interests of the people who live there.
• Integrated Working: a Guide (June 2004) offers practical help to those responsible for integrating services for children and for adults of all ages. It has been updated in 2008 - A Practical Guide to Integrated Working gives insight into effective integration and provides more practical guidance for planning and implementation.
• Integration and Partnership Working: what's working, not working and how it can be encouraged (January 2006).
• We have to stop meeting like this: the governance of inter-agency partnerships (November 2006) offers a number of frameworks, and discusses key issues such as democratic accountability and Local Area Agreements.

The Joseph Rowntree Foundation (JRF) has published a guide: More Responsive Public Services? A Guide to Commissioning Migrant and Refugee Community Organisations (MRCO's).  Migration is changing the face of Britain’s population. It has accounted for about half of Britain’s population growth in the last ten years. This guide’s main aim is to set out the case for MRCOs as providers of commissioned public services – both to show commissioners why they should consider them, and help MRCOs understand and form their own views on what their potential roles could be. July 2009.

Back to top