NHS trusts raise ‘significant concerns’ over ‘single responsible person’ plan

Health and local government figures are split over plans to introduce a single accountable figure for the NHS and ‘place-level’ care services, early reactions to the government integration white paper suggest.

Yesterday’s document, Health and Social Care Integration: Joining up care for people, places, and populations, outlined plans for a single accountable leader to oversee integrated health and care place boards within systems broader integrated care. But while local government has largely welcomed the idea, NHS representatives have expressed concerns.

Boards are expected to typically operate at local authority level, bringing together health and local government to pool budgets and produce a shared plan for health and care services in the area.

The white paper said appointing a single person responsible for implementing this plan would “ensure a more joint approach between health and social services”.

The individual will need to be approved by the ICS Integrated Care Board and “local competent authorities”, which LGC says refers to higher-level authorities.

The Local Government Association hailed a ‘strong role for local care and health leadership’ while the County Councils Network went further, describing as ‘essential that an individual from local government be the ‘sole person in charge’ “.

CCN Adult Social Care spokesperson Martin Tett (Con) said: “These higher level authorities should also be the ones to lead the design of the most effective local structures to focus on improving options community care and tackling the broader determinants of ill health, working alongside primary care partners.

Paul Najsarek, health and care spokesperson for the Society of Local Authority Chief Executives & Senior Managers, told LGC while there should be local flexibility over who fills the role, it was essential that the individual is accountable to the local authority.

He said: “One of the things that is key for us is that the chief executive and the board are properly connected to the arrangements, so if it’s not the chief executive of the board in that role, whoever it is has accountable to the council as well as the NHS.

He suggested directors of adult social services or public health could also be appropriate role holders with an important role for local government in helping to ensure a system-wide approach to addressing current challenges.

“In the short term, the focus will be largely on Covid and backlog issues in the NHS,” he added. “If you deal with them strategically, it will involve local government, but what we need to avoid are organizations going back to their own world to solve narrow problems.

However, representatives of the health service were less positive about the new role.

Saffron Cordery, deputy chief executive of NHS providers who represents hospitals and other NHS organisations, said: ‘We still have significant concerns about the proposal for a single responsible person at each location.

“This could further complicate accountability lines in already complex and developing system work structures.”

Despite government enthusiasm for the role, it is not statutory and will not alter existing accountability arrangements within the NHS or local government.

Hugh Alderwick, policy manager at the Health Foundation, said: “The proposal for single leaders for health and social care in local ‘places’ sounds simple but can cause disruption and additional layers of management.

“And the fundamental differences between how the NHS works and social care systems will remain intact.”

The Chartered Institute of Public Finance & Accountancy, which has members in councils and the NHS, has also raised concerns about the complexity of the new health and care system, which is also undergoing reforms in the framework of the bill on health and care currently being considered by Parliament.

Eleanor Roy, Cipfa’s head of health and social care policy, said: “Local variation means that one size does not fit all, so the proposal to add another level of advice based on the location can add complexity to the already cluttered landscape of integrated care councils, partnerships and health and wellness councils.

“That might turn out to be advice too far.”