The bringing together of health and care services has been a dominant policy for over a decade aiming to provide high-quality, sustainable services and improve health and wellbeing outcomes. Integrated systems can take many forms, depending on local need and circumstance. The evidence base shows that transformation, where successful, is iterative and requires trial and error, incremental change, and sustained effort and commitment. Nevertheless, there are key elements and characteristics that need to be addressed in order to succeed.

Finance is one of those key elements in achieving integration. Local authorities and NHS bodies are increasingly using system wide financial arrangements including pooled budgets, financial incentives, and risk and gain shares to better target pressured resources. Assessing new care models and new organisational models also relies heavily on finance as part of ensuring that services are better joined up to improve people’s outcomes and experience of health and care. However, combining two historically discrete national systems is a challenge that is requiring local financial leaders to adopt an open and honest approach to overcome the various barriers to working together effectively.

This tool is a module of the ‘Stepping up to the Place: facilitated integration tool’ and is designed to offer health and care system finance leaders a more in-depth self-assessment on the financial elements of health and care integration within their local system, helping them better enable improvement in outcomes and manage the risks.

This framework of questions has been designed by the Local Government Association (LGA), the Chartered Institute of Public Finance and Accountancy (CIPFA), and a reference group of sector partners, to support financial system leaders to identify their ambitions, commitment, capability, and capacity to make meaningful progress towards a fully integrated local health and care system. It is designed to be a facilitated self-assessment and should be used following a Stepping up to the Place workshop or a system-wide peer challenge.