A report by the Society of Local Authority Chief Executives sets out the principles the organisation believes should inform next-stage approaches to health and social care integration. CareKnowledge editor Jim Kennedy considers the key findings of the Solace report: 

A report by the Society of Local Authority Chief Executives sets out the principles the organisation believes should inform next-stage approaches to health and social care integration. CareKnowledge editor Jim Kennedy considers the key findings of the Solace report. 

I usually have only a limited time to prepare my blogs, which means I can miss key nuances in major publications. That may be the case with the Solace report. But with the time I’ve had, it seems to me that there is a large elephant in the room, which needs to be more fully explored than I believe it is in the report.

The issue that I think begs more detailed debate is the degree of devolution that the report’s recommendations truly imply for the NHS.

To illustrate more clearly why I make this point, I need to go to Solace’s press release introduction for the report. That makes it clear that Solace believes much fuller integration is desirable and inevitable, and goes on to note that this will require structural reform.   

But it seems to me that the structural reform the report describes comes generally below the strategic level. What are envisaged as the goals of reform are shared commissioning, shared budgets and shared management teams. Those objectives would be delivered by “Health and Wellbeing Boards providing strategic, local leadership, across the system.” 

Taken together (and with a recognition that different areas will ‘evolve’ differently), these form the first principle for reform, set out in the report. 

The proposed role for Health and Wellbeing Boards seems to me to pose big questions, though, about the national structure and management of the NHS and about the degree of devolution that would be necessary to support effective integration at the local level.  

Discussions about the degree and type of NHS devolution are even more important because, as far as I can see, the policy document takes an holistic view of health and social care integration, as opposed to one focused on specific services or client groups. 

(Such an holistic view seems necessary given the need for better health service integration as a precursor to anything more ambitious for health and social care.)   

Maybe the decisions not to develop arguments about the implications of Health and Wellbeing Board leadership – and instead simply state a desired local end-point that signals the issue – is a wise one given the historical difficulties of delivering a more devolved, and locally democratically accountable NHS. 

But I believe these issues need honest debate, even though that carries some risks. 

If we really want more fully integrated local services, and if we believe in the value of local democratic accountability, devolving the bulk of accountability for the NHS to a local level could deliver real joined-up local services under a single management structure.  

The risk, from a local government point of view, in addressing that debate directly, is that Government might prefer the option of achieving integration through bringing social care into the NHS, and creating a National Health and Care Service. 

But, if the two obvious routes to complete integration – either at the local level or the national level – are discounted, achieving real change, which the public across England will be able to touch and feel, may be difficult.

Commentators have been queuing up for some time to say that years of tinkering have failed to deliver effective integration. Providing a ‘leadership’ role for Health and Wellbeing Boards, and allowing a ‘differential devolution’ for localities to develop at a variety of paces, may be seen as unlikely to deliver the step-change in integration that national politicians want to see.