The Government published its integration white paper, “Joining up care for people, places and populations” last week. The white paper provides more detail of the expectations for place-based working between the NHS and local government, and includes the following key proposals:

• There should be shared outcomes agreed between the NHS and local authorities at local (“place”) level which will sit alongside a concise number of national priorities. Implementation of those shared outcomes should begin from April 2023.
• By spring 2023, all places should adopt a model of accountability and provide clear responsibilities for decision making including over how services should be shaped to best meet the needs of people in their local area. There should be a clearly identified person responsible for delivering those shared outcomes.
• New guidance on the scope of pooled budgets will be published in spring 2023.
• The Department of Health and Social Care (DHSC) will work with the Care Quality Commission (CQC) and others to ensure that the inspection and regulation regime supports and promotes the new shared outcomes and accountability arrangements at Place level.

Why organise care at place level?

This has been advocated for many years as a means of addressing two key issues. Firstly, meeting people’s real needs often requires co-ordination across services and agencies. Secondly, organising care on a “bottom-up” basis enables those planning and delivering services to respond to varied local needs and priorities.

What is the governance model for place-based partnerships?

There is no “one size fits all, model, but the white paper indicates that all places within an integrated care system (ICS) should adopt a governance model which achieves three objectives:

1. A clear, shared, resourced plan across the partner organisations for delivery of services within scope and for improving shared local outcomes.
2. Over time, a track record of delivery against agreed / shared outcomes.
3. A significant and, in many cases, growing proportion of health and care activity and spend within that place, overseen by and funded through, resources held by the place-based arrangement.

The white paper includes the following diagram to illustrate the relationship between the 'place board', the integrated care board (ICB) and local authorities. In this model, the relevant council and ICB would delegate certain functions and budgets to the place board, which would commission services from health and care providers.

This model should be considered alongside the options for place-based governance described in NHS England and NHS Improvement’s (NHSE&I) guidance “Thriving places - Guidance on the development of place-based partnerships as part of statutory integrated care systems”. This guidance describes five possible governance approaches, namely:

• Consultative forum
• Individual executives or staff
• Committee of a statutory body
• Joint committee
• Lead provider

Each approach has its benefits, and places will need to choose the model that best suits their particular circumstances and the nature and maturity of relationships between partners. 

How can Capsticks help?

We can help you to choose the most suitable structure for your place-based partnership by providing a briefing paper on the available options; their respective pros and cons, and how they can be implemented. This can be presented in a workshop for you and your local partners. Once you have agreed on the preferred approach to place-based working, we can prepare the documents that are required to support that approach, which may include:

• Memoranda of Understanding
• Delegations from the ICB
• Terms of Reference for committees and joint committees
• Lead provider and alliance contracts
• Section 75 agreements between the NHS and local authorities.

For more information or to have an initial free consultation about your plans for place-based working please contact Peter Edwards or Jamie Cuffe.