Co-commissioning driving integration

These examples show how co-commissioning between the NHS and local government can align resources, embed prevention, and deliver integrated support at scale. By pooling budgets and priorities, partnerships have been able to design services around people’s needs rather than organisational boundaries, achieving more sustainable outcomes and reducing inequalities. 

Greater Manchester: Integrated co-commissioning for complex needs

In Greater Manchester, pooled budgets between the ICB and local authorities were used to jointly commission services for people with complex needs. NHS trusts played a central role in delivering the health components of this model, working alongside housing, social care, and employment services to provide wrap‑around support. Key partners included Greater Manchester Mental Health NHS Foundation Trust, Pennine Care NHS Foundation Trust, and acute trusts such as Manchester University NHS Foundation Trust, which linked hospital discharge pathways with community services. 

Multidisciplinary teams were commissioned to span housing, mental health, social care, and employment support. NHS trusts embedded clinical expertise into these teams, ensuring patients received therapeutic care, crisis prevention, and pathways into specialist services, while local authorities provided housing stability and employment opportunities. This integration meant services were designed around individuals rather than organisational boundaries. 

The outcomes have been notable. Delayed discharges from hospital have reduced, as patients are supported with housing and community services more quickly. Housing stability has improved, enabling people with mental health needs to live independently, while employment support has been strengthened through integrated pathways. Crucially, prevention was embedded into commissioning decisions, directing resources toward tackling root causes such as poor housing and social isolation. 

Tower Hamlets: Joint commissioning to prevent childhood obesity

In Tower Hamlets, commissioners worked closely with the local authority, NHS trusts, and voluntary organisations to tackle persistently high rates of childhood obesity. A joint commissioning framework was established to pool resources and align priorities across the borough. The local NHS trust, Barts Health NHS Trust, worked alongside Tower Hamlets Council and voluntary partners to design and deliver a comprehensive prevention strategy. This included funding school based nutrition programmes, community cooking classes, and the redesign of local play spaces to encourage physical activity. 

The involvement of NHS trusts was critical in embedding health expertise into the programmes. Clinicians and public health teams from Barts Health supported schools with nutrition standards, provided input into community education, and ensured that interventions were evidence based. By working in partnership with the council and voluntary organisations, the NHS helped shift services upstream. The impact has been clear. Within three years, obesity prevalence among 10-11 year-olds dropped faster than the London average. School programmes improved children’s diets, community cooking classes empowered families to make healthier choices, and redesigned play spaces encouraged physical activity and community engagement. 

Leeds: Co-commissioning housing and mental health support

In Leeds, the ICB and city council jointly commissioned integrated housing and mental health support services. Leeds and York Partnership NHS Foundation Trust embedded community mental health teams into "Housing First" style programmes, combining tenancy support with mental health and addiction services. While Leeds Teaching Hospitals NHS Trust linked hospital discharge pathways with housing and community services, ensuring patients received timely support. 

The results have been significant. Rough sleeping has reduced, tenancy continuity has improved among people with severe mental health needs, and stabilising housing has lowered A&E attendances and crisis admissions. This demonstrates how joint planning and commissioning of housing and health services, can reduce crisis demand, improve independence, and tackle inequalities more effectively.