21/09/2026
📌📌Health and social care: Why isnt it currently working?📌📌
The difficulty with health and social care is often presented as a question of funding.
But another question is whether the statutory framework actually makes the different parts of the system work together.
The law already contains substantial integration provisions.
Care Act 2014, s.3 requires a local authority, in exercising its care and support functions, to PROMOTE INTEGRATION with NHS and other health-related services.
Care Act 2014, s.6 imposes a general DUTY OF CO-OPERATION on local authorities and relevant partners.
Care Act 2014, s.7 requires cooperation in individual cases where the authority requests it.
NHS Act 2006, s.82 also imposes a duty on NHS bodies and local authorities to cooperate to advance the health and welfare of people in England.
The Health and Care Act 2022 went further. It created Integrated Care Boards and Integrated Care Partnerships and inserted NHS Act 2006, s.14Z42, requiring ICBs to exercise their functions with a view to integrating health services with social care and health-related services where this would improve services or reduce inequalities.
There are also existing mechanisms for joint working and funding. The Better Care Fund operates under NHS Act 2006, s.223GA, and the Health and Care Act 2022 provides powers for NHS bodies and local authorities to delegate and jointly exercise functions.
So what is actually missing?
1. NO SINGLE STATUTORY OWNER OF THE CARE PATHWAY
The legislation requires organisations to cooperate, but does not generally appoint one body to be legally responsible for coordinating an individual's entire health and social-care pathway.
Proposed provision:
A new statutory Lead Care Coordinator for people with complex or continuing needs, with responsibility for coordinating NHS, social care, rehabilitation and community services.
2. NO UNIVERSAL SINGLE HEALTH AND SOCIAL-CARE PLAN
The Care Act provides for assessment and care planning, and the NHS has its own care-planning arrangements.
But there is no universal statutory requirement for one integrated plan covering the person's NHS and social-care provision together.
Proposed provision:
A statutory Integrated Care Plan, with prescribed minimum information and a requirement for participating NHS and social-care bodies to work from it.
3. NO STATUTORY “INTEGRATION FAILURE” PROCEDURE
There are duties to cooperate and promote integration.
But there is no specific statutory procedure which is automatically triggered when failure to coordinate results in a person's care being delayed or disrupted.
Proposed provision:
An Integrated Care Failure Review, requiring the relevant bodies to identify the failure, determine responsibility and implement a remedial plan within a prescribed period.
4. NO SINGLE STATUTORY CAPACITY PLAN
There are existing duties concerning NHS planning and the sustainability of the social-care market, including Care Act 2014, s.5.
But there is no single statutory requirement to plan the capacity of the entire local care pathway together — hospital beds, domiciliary care, residential care, rehabilitation, reablement and workforce.
Proposed provision:
A statutory Joint Health and Social Care Capacity Plan, prepared annually by the ICB and its local authority partners.
There is an important point about funding too.
The law and guidance already provide mechanisms for dealing with disputes. For example, the NHS Continuing Healthcare framework states that disputes between ICBs and local authorities should not delay the care package, with arrangements for funding pending resolution.
So the answer cannot simply be:
“We need more legislation.”
The better legal question is:
Where existing duties are not producing integrated care, should Parliament create clearer statutory accountability and enforceable outcomes?
The patient does not experience an ICB, a local authority, an NHS Trust and a care provider as separate legal entities.
They experience one care pathway.
New statutory end-to-end accountability. Let's look at what each party already thinks about this:
Labour: Not specifically developed in the manifesto
Conservatives: Not specifically developed
Lib Dems: Not specifically developed
Greens: Not specifically developed
So as they say on the London Tube, Mind the Gap!
If virtually everyone accepts that health and social care need to be joined up, why does the statutory framework still leave responsibility divided between different bodies?
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