LocalGovernmentLawyer Adult Social Care 2017 29 The guidance focuses on the need for decisions to be informed by consultation with stakeholders and to be targeted at achieving the outcomes which matter most to people in that local authority's area. There is a very clear emphasis on contracts securing good quality, sustainable provision and on the need to base price and funding level decisions on local market intelligence and the costs of local quality provision. Authorities will be expected to demonstrate that their contracts with providers fulfil their obligations under the Act, and that commissioning decisions are evidence-based ,including consideration of evidence about how providers treat their staff. Integrated and joint commissioning What is integrated commissioning? There is a continuing drive towards integration of health and social care services with obligations to co-operate placed on local authorities, CCGs and NHS bodies under NHS Act 2006, s 82 the development of Health and Wellbeing Boards and the introduction in 2013 of the Better Care Fund (BCF). The BCF is a single pooled budget to promote the integration of health and social care services at a local level, drawn from the budgets of local authorities and CCGs. Health and Wellbeing Boards (HWBs) are comprised of representatives from the local authority, the relevant CCG and a representative of the Local Healthwatch organisation and are designed primarily to promote integration. HWBs have a role in producing a Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS) and holding local authorities and CCGs to account in relation to these. Therefore consideration should be given to the statutory provisions which facilitate or enable, and legal requirements on such commissioning which is integrated across local authorities and Clinical Commissioning Groups (CCGs). Integration is not a legally defined term and integrated commissioning can take a number of forms. It may mean: ● one commissioner acting as lead to commission both health and social care services (whether in the form of an integrated care pathway or as inter-linked services) ● each commissioning body commissioning services themselves, but using an aligned approach (eg joint specifications and processes) ● commissioners pooling their budgets, or using separate budgets or funding streams which are applied or managed in an aligned way, in order to cover provision of both health and social care services What are the legal requirements for integrated commissioning? Integrated commissioning does not reduce or remove any of the legal requirements which would apply to non- integrated commissioning set out above. In addition, to ensure that authorities comply with legal requirements and can demonstrate that compliance: ● all integrated or joint commissioning arrangements must ensure that: ● the written agreement clearly specifies the authorities/delegations for decision-making and arrangements for governance, and ● each organisation is able to track their legal duties through the arrangement to ensure that they will be fulfilled ● where authorities participate in joint/integrated commissioning processes which will secure the provision of health services other than those for which authorities are responsible under NHSA 2006, it is likely that the commissioning process will need to comply with the requirements of the NHS procurement and competition regime as set out in the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013, SI 2013/500 ● where a local authority is delegating functions to a CCG or vice versa, the legal mechanism governing such delegation is still NHSA 2006, s 75 and the regulations under that section, NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000, SI 2000/617. The regulations require the authority and the CCG to enter into a written agreement to cover the delegation and set out requirements as to the content of the agreement. Particular requirements apply where the arrangements involve a pooled budget. New provisions relating to the devolution of healthcare to Combined Authorities inserted at NHSA 2006, s 75(7)(A)–(F) by section 19 of Schedule 4, paragraphs 1–6 to the Cities and Local Government Devolution Act 2016 are beyond the scope of this Practice Note ● where an integrated arrangement is entered into as a mechanism for pursuing plans approved under the BCF, the CCG is accountable for the use of the funding and as such has to comply with NHSA 2006, s 223GA. This provision requires that a pooled fund be established and allows NHS England to impose conditions on particular CCGs regarding use of the funds. BCF arrangements, including the relative responsibilities of the CCG(s) and local authorities, are often defined through agreements under NHSA 2006, s 75. All BCF plans should be approved by the relevant HWB ● local authorities and CCGs should be able to demonstrate that they have had regard to the JSNA and JHWS, as required under s 116B of the Local Government and Public Involvement in Health Act 2007. Section 196(3) of the Health and Social Care Act 2012 gives HWBs the right to serve an opinion on their local authority if they believe that they are not acting in accordance with their JSNA and/or their JHWS At present, there are various challenges to the integrated provision of health and social care, including: ● cultural differences: in some circles of local government CCGs are perceived as being target-focused, whereas, as discussed above, local authorities are required to be more person-centric in their approach to commissioning services ● accountability: CCGs and local authorities are subject to different accountability mechanisms ● influence of politics: ● local authorities are more likely to be directly affected by cyclical politics and popular perception, which may cause divergences in how decisions are made, and ● key people within local authorities may change on a relatively regular basis, making it difficult to build up significant