Recommendation 11

There is a well-established interdependency between health and local government, with local authorities responsible for managing local social care markets. The stability and resilience of social services have a direct impact on the NHS. High-quality social care, if available, can keep people independent, healthy, and out of hospital.31 Despite the aspiration for ICSs to better integrate health and care, we are concerned the underlying reforms do not address long-standing differences between the sectors and may be a missed opportunity to make more meaningful progress on how the NHS and local government work together. The NHS and social care continue to maintain separate budgets and we challenged our witnesses on whether this is the best way to ensure people receive the services they need.32 NHS England highlighted pre-existing mechanisms such as the Better Care Fund, which has been in place since 2015, as a way for the NHS and local authorities to collectively pool budgets and agree how the money is then spent locally, and the Department wrote to us after the evidence session with examples of how the fund has been used and to what benefit.33 However, the Department noted several times during the session that the ICS reforms are not intended to alter the funding that either the NHS or local government receives or change existing accountabilities and statutory responsibilities, but are instead intended to provide a forum for better decision-making to take place.34