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Figure 4: What additional powers/responsibilities do you think

Health and Wellbeing Boards should take on?

67%

63%

33%

30%

21%

Strategic oversight

of acute provision Commissioning of

primary care in

partnership, e.g.

through a joint

vehicle with the CCG Right to scrutinise

contracts more

closely

Other* (please

specify)

Commissioning of

primary care directly

The right to scrutinise contracts more closely was supported by a third of our

survey respondents (see figure 4), and was raised in some interviews as the

only way that HWBs would be able to truly influence primary commissioning

decisions. But the most popular responses by some way were to allow HWBs

to have strategic oversight of acute provision and to commission primary care

in a partnership. This would chime with Labour's proposals.103 In order for

HWBs to hold NHS England accountable for commissioning our 2013 report

'In Sickness and in Health' recommended that a body for HWBs should be

created to represent their interests within NHS England.104

Our conclusion is that if the sector wants to go for all-out integration, then it

should build on the spirit and intention of BCF and do it wholesale. This would

chime with our survey respondents who by an overwhelming margin (85 per

cent) were in favour of "increased financial incentives for closer integration e.g.

an expansion of the BCF"

Co-location of services, aimed at reducing unnecessary acute admissions - for

example, by putting GPs and social workers in hospitals full time - were seen

by several interviewees as a worthwhile investment. A case in point is Barnet,

where there are social care workers and more than 70 GPs and 60 nurses

providing 24-hour cover in three hospitals and one primary care centre.105 The

expansion of this gatekeeper role could play a critical part in supporting older

people outside of an acute setting.

But by the same token, pilots have shown that integrated, preventative care

outside hospitals can work, too. For example, Leeds has been chosen as one of

14 sites across the country to pioneer integrated care. Twelve health and social

care teams in Leeds coordinate the care for older people in a recovery centre.

This centre offers rehabilitative care to prevent otherwise avoidable hospital

admission, facilitate earlier discharge and promote independence. In its first

month of operation the centre reported a 50 per cent reduction in length of stay

at hospital.106 Smaller schemes can also have a large impact. An interviewee

told us that taking an acute cardiologist out of the local hospital and into the

community led to a 25 per cent reduction in hospital admissions.

103 HSJ "Burnham sets out

integration vision" (24

September 2014)

104 Localis, In sickness and in health

(September 2013)

105 Barndoc Healthcare, About us

(accessed January 2015)

106 Department of Health,

"Integration pioneers leading the

way for health and care reform"

(1 November 2013)

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