Integration, cooperation and
partnerships
Care Act 2014
Outline of content
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Introduction
What the Act says and the duties that fall to local authorities
The duty to promote greater integration
The duty to cooperate
Integration, cooperation and partnerships in practice
Working together: examples
Summary
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Integration, cooperation and
partnerships are not new concepts
 NHS Reorganisation Act 1973
 The New NHS: Modern, Dependable 1997
 Health Act 1999
 Independence Wellbeing and Choice 2005
 National Health Service Act 2006
 Health and Social Care Act 2012
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Why integration, cooperation and
partnerships?
 Improves the service user experience
 Eliminates duplication
 Streamlines care pathways
 Early intervention and prevention
 Improves safeguarding
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What do we mean by integration,
cooperation and partnerships?
 Integration: The combined set of methods, processes and models that
seek to bring about improved coordination of care
 Cooperation: Public organisations working in partnership to ensure a
focus on the care and support and health and health-related needs of
their local population
 Partnership: A joint working arrangement where the partners: are
otherwise independent bodies; agree to co-operate to achieve a
common goal; create a new organisational structure or process to
achieve this goal; plan and implement a joint programme; share
information, risks and rewards
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What does the Act say?
Sections 3, 6, 7 and 43 of the Act require that:
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“A local authority must exercise its functions under this Part with a view to
ensuring the integration of care and support provision with health
provision and health-related provision”
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“A local authority must co-operate with each of its relevant partners, and
each relevant partner must co-operate with the authority, in the exercise
of their functions relating to adults and carers”
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“Local authorities and their partners must co-operate where this is needed
in the case of specific individuals who have care and support needs”
43. “Each local authority must establish a Safeguarding Adults Board (SAB)
for its area... The way in which a SAB must seek to achieve its objective is
by co-ordinating and ensuring the effectiveness of what each of its
members does.”
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What is the vision?
“The vision is for integrated care and support that is
person-centred, tailored to the needs and preferences of
those needing care and support, carers and families.”
Care and Support Statutory Guidance October 2014
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Under what circumstances?
 This duty applies where the local authority considers that the integration
of services will:
 “promote the wellbeing of adults with care and support needs or of
carers in its area;”
 “contribute to the prevention or delay of the development by adults
in its area of needs for care and support or the development by
carers in its area of needs for support, or;”
 “improve the quality of care and support for adults, and of support
for carers, provided in its area (including the outcomes that are
achieved from such provision).”
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Other legislation
 The Health and Social Care Act 2012 (Sections 13N and 14Z1) also
states that the NHS also has a duty to promote and secure integrated
care where it will improve the quality of services, and reduce
inequalities in accessing services or improve outcomes.
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The five aims of cooperation
1. Promoting wellbeing
2. Improving the quality of care (including the outcomes from such
provision)
3. Smoothing the transition from children’s to adults’ services
4. Ensuring agencies work effectively together to safeguard adults at risk
of abuse or neglect
5. Reviewing and learning lessons from cases where adults have
experienced abuse or neglect
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With whom should local authorities
cooperate?
District
Councils
Other
authorities
Local
authorities
Others
CCGs
Health
Cooperation
Prisons and
probation
Hospital
trusts
NHS
England
DWP
Police
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Cooperation in specific cases
 The general principle is one of cooperation in the day to day delivery of
care
 But there might be a need for cooperation, in the case of individuals,
which goes beyond the general requirement
 If specific cooperation is requested, either from the local authority or by
the local authority, the partner organisation must respond unless it is
incompatible with their own functions and duties
 A person or agency must comply with a request for information from a
Safeguarding Adults Board under certain conditions regarding issues
involving a safeguarding case
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Integration, cooperation and
partnership in practice
 Partnership, cooperation and integration need to be key components of
a local authority’s strategic approach. This may be with a range of
organisations (including other local authority functions, public sector
organisations and the independent and private sector) and occur in a
number of ways:
 Planning and commissioning
 Assessment and information
 Care delivery
 Quality assurance
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Working with health services
 Integration and cooperation must be delivered in the context of
improving care and support, in line with the duty to promote wellbeing,
prevent or delay the development of needs and improve the quality of
care
 There is a reciprocal duty placed on the NHS, specifically any NHS
body within the authority’s area including Clinical Commissioning
Groups, hospital trusts and NHS England
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The boundaries of co-operation
 Local authorities have a duty to meet eligible needs for care and
support
 Local authorities have a duty to make enquiries in cases of abuse
 But there are restrictions on what they can provide in terms of health
care, for example:
 Nursing care provided by registered nurses
 NHS Continuing Healthcare funded care
 All partners need to be clear about their own responsibilities, and how
they fit together
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Discharge of hospital patients with
care and support needs: Delayed
Transfers of Care (DTOC)
 A key area for local authorities and the NHS to consider working
together
 Provisions are made within the Act to reflect current care and support
landscape for people who have both health and social care needs
 The NHS can seek reimbursement from Local Authorities for a DTOC.
This is intended to act as an incentive to improve joint working
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Working with housing
 Suitable living accommodation is a key ingredient in promoting physical
and emotional health and wellbeing
 Housing can also prevent or delay care needs from arising; as well as
support existing needs
 Local authorities must provide information and advice on care and
support and this must include housing services
 Local authorities are not expected to provide all housing services but
should “make effective use” of other statutory, voluntary and private
resources
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Working with employment, training
and education services
 The wellbeing principle includes participation in work, training and
education and as such local authorities must consider this as part of
their care and support functions
 Local authorities must:
 Consider the links between care and support, employment and
welfare when planning and commissioning
 Ensure good quality information and advice including eligibility for
benefits, disability benefits and employment support
 Consider education, training and support when working with
individuals
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Working together: examples of
integration, cooperation and
partnerships
 Strategic planning by building better commissioning arrangements or
joint commissioning teams
 Commissioning integrated services, or jointly commissioning specific
services such as advice and advocacy services
 Assessments, information and advice such as integrated health,
care and housing assessments
 Delivery or provision of care via integrated community teams, or
working with housing providers to ensure that adaptations support
independence, reablement or recovery
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Strategic planning
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Joint Strategic Needs Assessment (JSNA)
Joint Health and Wellbeing Strategies and commissioning strategies
Local Development Frameworks
Joint commissioning teams
Joint governance structures
Pooled budgets
Development of combined approaches to the market through joint
market position statements
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Commissioning across agencies
Separate independently
and without coordination
Parallel – with
reference to
other agencies
Joint – in
partnership by
separate
agencies
Combined –
through a single
organisation or
partnership
Agencies have
separate
approaches and
do not liaise e.g.
the financial
impact of services
and policies on
other agencies is
not considered
Agencies liaise
over
commissioning
activities e.g.
separate cost,
benchmarking
and market
intelligence
shared by
agencies
Agencies work
jointly on
commissioning
activities e.g. a
jointly researched
and produced
market position
statement
Single, combined
functions or
arrangements
e.g. a single,
integrated
commissioning
function
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Integrating assessment and
information
 Joint information and advice service - based around the needs of the
end user rather than around individual services or structures
 Integrated assessment processes
 “Care co-ordinators”
 Integrating assessment and care planning for carers
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Integrating service delivery
Occupational
therapy
Care and
repair
Reablement
Assistive
technology
District
nursing
Physiotherapy
Community
alarm
service
Home
Care
The need to integrate provision to help keep people within the community
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Summary
 The Care Act ensures that people should experience provision that
works well together and where each participant know what the others
are doing and why
 The responsibility goes wider than just integration and cooperation with
health services but to other services that provide care and support
 The duty to cooperate is not just one way, and involves both a general
requirement to cooperate as well as a specific requirement in the case
of individuals
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