1999–2003
Health Act 1999
Flexibilities introduced to encourage more integration, e.g. pooled budgets, lead commissioning arrangements (where local authorities or NHS bodies could delegate service procurement to the other), and formation of “one-stop shops' for health and social care services.
NHS Plan 2000
Invested in intermediate care services, which included expanding rehabilitation services within hospitals, establishing hospital at-home care teams and community rapid response teams; ensured nursing care provided in homes would be funded by NHS. Supported joint inspections across health and social care organisations.
Health and Social Care Act 2001
Care Trusts established, partnerships that pool health and social care resources in one organisation to commission and/or provide a range of services such as social care, mental health, or community care.
Community Care Delayed Discharges Act 2003
Required local authorities to pay health care providers when a delayed NHS discharge was due to appropriate local community care services being unavailable.
Our health, our care, our say: a new direction for community services 2006
White paper committed to developing joint health and social care records and care plans, develop aligned planning and performance management system between the NHS and local government, and greater case management and multi-disciplinary teams; appointed social care lead to Department of Health board
National Health Service Act 2006
Established Section 75 partnership agreements, which expanded flexibilities for NHS and local authorities to pool budgets and to integrate functions and management structures.
Partnership for Older People Projects (2006 – 2009)
The Department of Health funded 29 projects led by local authorities, in partnership with their local primary care trusts and representatives of the voluntary, community and independent sectors. Their aim was to “shift resources and culture away from institutional and hospital-based care for older people towards earlier, targeted interventions within their own homes and communities”
Putting people first: a shared vision and commitment to the transformation of Adult Social Carel 2007
Committed to ensure independent living for all adults through a joined-up and collaborative partnership between local and central government, the voluntary sector, providers and the social care regulators. Set vision for system-wide transformation, including expanding joint strategic needs assessments and commissioning and co-locating services.
2004 – 2009
High quality care for all: NHS Next Stage Review 2008
Committed to support greater patient choice and control, through joint commissioning and planning. Promoted greater provision of care in the home and personalised care plans. Introduced concept of Integrated Care Organisations which would bring NHS and social care providers together under single budgets to deliver more coordinated services.
Integrated Care Pilots (2009- 2012)
Committed to support greater patient choice and control, through joint commissioning and planning. Promoted greater provision of care in the home and personalised care plans. Introduced concept of Integrated Care Organisations which would bring NHS and social care providers together under single budgets to deliver more coordinated services.
CQC established 2009
Evolved inspection to look at how health and social care work together (analysing whole systems, care pathways, and transitions between services, how they are commissioned and the role of partner organisations).
2010–2014
Spending Review 2010
Transferred £2.7 billion from the NHS to local authorities over the four years to 2014-15, to improve collaborative working
Whole Place Community Budgets 2011
Five-year pilot programme that gave areas funding for five years to develop new models for joint working across local services. Most focused on broader public services, but Greater Manchester pilot had core focus on health and social care integration.
Health and Social Care Act 2012
Established local health and wellbeing boards with a duty to encourage the integrated commissioning of health and social care services. Introduced new rules to facilitate competition across providers, but required newly formed NHS England and clinical commissioning groups to promote integration where this would improve quality or reduce inequalities. NHS Improvement also given duty to remove barriers to integrating care when in the interests of patients (trumping its role in applying competition rules).
Integrated Care: Our Shared Commitment 2013
Set out shared vision by Department of Health and 12 partner organisations to make integrated care the norm by 2018, committing to a common purpose, developing national resources, and integrating information across systems.
Spending Review and Better Care Fund 2013
Set up plans for Better Care Fund, which required CCGs and local authorities to pool existing funding and develop joint plans to: prevent gaps in health and social care and avoid unnecessary emergency admissions; support better data sharing and joint care assessments and planning; and demonstrate impact on acute sector. In 2015-16, the Fund comprised of £3.8 billion, made up of transfers from the NHS to social care, and contributions from local authority grants.
Integrated Care and Support Pioneers (2013-2019)
Selection of 25 areas (over two waves) to develop innovative models for improving coordination between health and social care services. Models pursued range of interventions but tended to focus on improved case management, community support, and multi-disciplinary working. Underpinned by joint approaches to information sharing and contracting models, and greater alignment of resources through local tariffs and budgets.
NHS Five Year Forward View 2014
Set vision for new model of care delivery and commissioning that would reduce inequalities and shift more services out of hospital and into the community.
New Models of Care Vanguards programme 2014
Set up seven new models of care based around the Five Year Forward View to be piloted at 50 ‘vanguard’ sites. Included models like enhanced health in care homes to offer more joined up health and rehabilitation services.
New Models of Care programme 2014
Set up seven new models of care based around the Five Year Forward View to be piloted as 50 ‘vanguard’ sites. Included models like enhanced health in care homes to offer more joined up health and rehabilitation services.
Care Act 2014
Required local authorities to promote integration of care and where this will benefit patients and quality of care.
2015–2020
Spending Review and Autumn Statement 2015
Created a social care precept to give local authorities ability to raise new funding to spend exclusively on adult social care. Announced additional £3.5 billion for social care through the Better Care Fund and social care precept; Established £2.1 billion Sustainability and Transformation Fund to support integration and improve patient experience and outcomes.
Sustainability and Transformation Plans 2015
NHS planning guidance introduced 44 new footprints that required local bodies to develop plans to support greater collaboration and address funding shortfalls. Key themes in plans included creating care hubs that bring together social care, mental health, and NHS services, changing organisational arrangements to support joint commissioning and contracting, staff pooling across organisational boundaries, shared care records, and outcomes-based payments.
Integrated personal commissioning pilots 2015
Sites chosen to join up health and social care support and funding at the level of the individual. Involved creating individualised budgets for people with long-term conditions, people with learning disabilities, frail elderly people and children and young people with health and social care needs to direct where and how money was spent.
City and Local Government Devolution Act 2016
Allows transfer of budgets and powers to combined authorities through devolution deals. In some places, like Greater Manchester, this included health and social care, where the combined authority established pooled budgets, took over commissioning responsibilities, and developed a strategy for integration.
Local Government 2017–18 financial settlement
The Department for Communities and Local Government introduced freedoms for local authorities to increase the social care precept by up to 3% 2017/18 and 2019-20.
NHS Long Term Plan 2019
Set vision that integration and place-based care would be central to how the NHS would accelerate progress in improving health in early childhood years, early diagnosis and prevention of major health problems, and support for people to age well. Committed each STP to becoming an Integrated Care System (ICS) that would give local areas more accountability and authority to control resources and support greater collaboration across the NHS and local authorities. Aligned payments in capitation based models, and built on vanguards programme to implement new care models that build alliances of providers supported by integrated care partnership contracts.
Hospital discharge and community support operating model and national discharge fund 2020/2021
Government introduced new funding during Covid-19 to help cover some of the costs of support packages of care and rehabilitation following discharge from hospital. Systems must ensure they provide adequate health and care discharge services 7 days a week to reduce length of stay in acute care, and improve outcomes following a period of rehabilitation and recovery and reduce the need for long-term care.
Health and Care Bill 2021–2022
Proposes legislative changes that would establish integrated care systems as statutory organisations, and create two new bodies: integrated care boards (composed of NHS bodies and local authorities that would replace clinical commissioning groups) and integrated care partnerships (collaborative boards involving the NHS, local government, and broader local partners) to develop integrated care plans. Requirements to competitively tender some clinical services will be removed to better support collaboration across providers.
Health and Social Care Levy and Spending Review 2021
Introduced a new approach to funding social care, including a lifetime cap on care costs and new means test limits (though recent amendments mean that the reforms might not protect those with lower assets from catastrophic costs). Introduced a new 1.25% levy that will be ringfenced to support UK health and social care bodies.
People at the Heart of Care: adult social care reform white paper 2021
Sets out 10-year vision for adult social care, which includes a range of policies and measures to improve the level of care and support available in communities. Includes specific ambitions and investments to: better integrate housing, community, health and social care services together as part of local strategies, improve discharges for hospital with more integrated technology and support plans; embed innovative models of care that integrate services and support people in their homes; and strengthen obligations for new Integrated Care Boards and NHS England to include carers when commissioning services.