Work on the Better Care Fund (BCF) plan has already started for most CCGs and local authorities with a timescale that is very short indeed - the 2 year plan needs to be completed by March 2014.

At a practical level how then should CCGs and local authorities respond to the need to create an integrated budget, let alone transformational services – and of course whilst the need to find a workable and practical solution is driven very immediately by the need to manage the transition of exiting funds through the BCF the underlying need is one created by demographics and austerity. Services must move closer to the home and focus more on early intervention and prevention.

Historical solutions have involved S75 Partnering Schemes but these have had mixed success. Some elements have worked well but the way S75 arrangements have been applied has all too often inhibited transformation at scale, often because there is lack of confidence in the financial outcome that respects the bias of EACH commissioner. Neither has the evidence or the confidence that intervening in new services will deliver the improved outcomes or cashable savings that are predicted, compounded by the need to fund and retain existing services whilst new interventions are introduced and assessed

A solution is now being sought through the use of an Integrated Services Agreement (ISA). This is a package that pulls together, in a flexible form, the benefits of Section 75 (pooling of budgets and lead or joint commissioning) with the best new models of commissioning outcomes, linking payments and hard edged outcomes with incentives through the use of an accountable lead provider. In appropriate circumstances existing funding can be augmented by social investment by incorporating a Social Impact Bond as part of the ISA. The structure is intended to be flexible enough to incorporate both enhanced community engagement (making the best use of co-production) as well as a disinvestment plan to support existing providers to manage the service transformation.

Integrated Services Agreement model

So, at its heart an ISA can deliver effective governance to support the outcomes that the individual partners needs to see from the overall project. The contract mechanisms will retain appropriately calibrated risk transfer for the providers so that there is clarity around the risks and benefits, buy in for the consequences and a clear route for managing complex issues.

This is a structure that can deliver integration transformation schemes. One that can map the relationship between the ISA governance and the Health and Wellbeing Board as well as with the CCG, the Council and other key stakeholders to support the development of coordinated or integrated services for individuals whose needs span different commissioning systems, cost effectively.  It can support the interconnectivity of data and the introduction of accountable lead providers where this is needed in short it is intended to provide the structure for both the strategic decision making around the re-design of Health and Social Care Services but also the practical implementation through effective contracting to enable the commissioners to assure themselves and manage the services that they need to deliver better outcomes for the people using care services.