Drawing on the five case studies and our wider engagement with trust leaders, there are several areas where national policy makers can support trusts to fulfil their role – as they have defined it locally – in place-based partnerships:

  • It will be important to maintain a flexible and permissive national policy and legislative framework. This will allow trust leaders and system partners to develop place-based partnerships, including leadership and partnership arrangements, that make sense in their unique local contexts and avoid creating additional bureaucracy. This flexibility was welcome in the Health and Care Act 2022, and in policy and guidance focused on place to date; it should be preserved as the integration white paper proposals and wider national reform agenda progress.
  • The government should continue to focus on practical enablers of integration. Addressing issues such as NHS and social care workforce integration and shared data, for example, could make a real contribution to truly joined up care at place level.
  • National policy makers should have realistic expectations of place-based partnerships. Trust leaders are optimistic and ambitious about place collaboration making a positive impact for local communities, but the operational and financial context remains challenging and places are working from different starting points. It will take time to demonstrate impact.
  • For place-based partnerships to succeed, the services that people access at place beyond those provided by trusts – adult social care, public health, primary care and the voluntary sector – need to be adequately resourced and able to recruit and retain enough staff. The government has taken a number of steps to reform adult social care, but more action and funding is required to ensure people receive the right care at the right time in the right setting.
  • Decisions about pooling and aligning NHS and social care budgets must be taken locally. Trust leaders are supportive of a strategic aim to make best use of collective health and care resources but remain cautious about the emphasis in the integration white paper on managing a growing proportion of health and care budgets through pooled or aligned arrangements. Trust leaders cite local government funding shortfalls as a key risk: combining budgets without addressing this underlying issue could exacerbate existing pressures on NHS budgets.
  • Place-based working will present new questions for national bodies about how they oversee quality and performance. Trusts are supportive of a focus on shared outcomes at place but detect risks in additional layers of oversight and monitoring. There is an opportunity to strike a balance as NHS England develops its new operating model, and CQC refines its monitoring and inspection approach.
  • National policy makers must support trusts to navigate the complexities of delivering integrated care at place and collaborations at scale across wider footprints. Trusts are involved in a myriad of collaborative arrangements, which will develop over time, and which all require good relationships, robust governance and leadership headroom. The respective roles of place-based partnerships, provider collaboratives and the integrated care board/partnership will need to be clearly defined by local partners.