As our population ages and more people need additional support across health and social care, integrated care boards and local authorities responsible for adult social care are being asked to do more with less. The result, as patients and families know too well, is fragmented care, delayed hospital discharges and service provision that is disjointed with people often left wanting and their care falling between the cracks.
Announced by the government last summer, the first phase of Baroness Casey’s Review of social care asks what pragmatic steps can be implemented within existing budgets in the medium term. At ADASS and the NHS Confederation, we’ve looked at what solutions our members, local leaders across health and local government, are already delivering.
We should be honest about how hard collaboration is right now
They show the case for closer, more consistent collaboration is essential if services are to remain sustainable and people are to receive the joined-up personalised care they need. Yet, the harsher the financial climate becomes, the more time and energy the NHS and local government spend negotiating with each other on who pays for adult social care – rather than actually supporting people who rely on them both. Frontline staff see the same pattern every day: pressure to discharge quickly on one side; pressure to ration scarce support on the other; and precious time lost arguing over who ultimately has the responsibility to deliver for those in their care.
This is not simply a funding problem. It is an interface problem, a fault line between two public services that frustrates staff, confuses families and slows down care right when someone needs it most.
Acknowledging the reality
We should be honest about how hard collaboration is right now. Local authorities have suffered severe cuts over the last decade. ICB staff are dealing with up to 50 per cent running cost cuts, constant restructures and deep uncertainty about their futures. Trust is fragile, capacity is thin and goodwill is stretched.
But precisely because the system is under such strain, collaboration is not a 'nice to have'. It is part of the solution. When money is tight, duplication, delay and dispute are luxuries we can no longer afford.
We really need to prioritise building relationships between and across professionals in both sectors based on trust. We will only be able to navigate through the new neighbourhood health and wellbeing model – local teams working together to proactively manage the health and care needs of their population – if we prioritise them.
One neighbourhood, one system
The only credible way to improve care within existing budgets is to treat social care and the NHS as part of one neighbourhood health and care system.
For residents and patients, this matters enormously. Joint teams can reduce the risk of people being passed back and forth between organisations arguing over funding responsibility. Properly training and remunerating social care works to deliver delegated health tasks – such as supporting people with catheter care, wound care or insulin administration and monitoring – can reduce pressure on NHS community care, improve people’s continuity of care, and offer career and pay progression opportunities for social care staff – improving workforce retention and in turn continuity of care for the people they support.
Social care workers deserve recognition as equal partners, not the last stop in a pressured system
In our new report, we have found local teams across the country that refuse to be defined by organisational boundaries and that have embraced neighbourhood health and wellbeing are already showing what’s possible:
- In Gloucestershire, the Integrated Flow Hub brings health and social care professionals together to make decisions once, together, and at speed – cutting days of delay and duplication.
- In Walsall, the Walsall Together model has delivered quicker responses, fewer avoidable admissions and better experiences for people and their families.
- Leeds, Sunderland, Bradford and Kent & Medway show the same pattern: when the NHS and social care act as one team at the neighbourhood level, outcomes improve and resources stretch further.
This is not theory. It is happening now. These models can be replicated.
Seven steps for 2026
To make collaboration a reality, what steps should the Casey Review consider and what can local leaders do now? We propose seven practical high-impact shifts that both local leaders and national government can make in 2026:
- Explore joint commissioning teams with pooled budgets between local authority and ICBs, reducing avoidable disputes and speeding up decisions
- Use upcoming health legislation to make this easier, by strengthening Section 75 arrangements and replicating Section 65z NHS freedoms to delegate functions for local government
- Scale delegated health tasks, delivered safely, with proper training and fair pay. This can relieve pressure on community care providers and open up career and pay progression opportunities for social carers
- Revise the Continuing Healthcare referral checklist, so only those patients likely to be eligible are referred to speed up assessments and access to care
- Review the Continuing Healthcare assessment framework to ensure a consistent approach which meets care needs
- Develop a more flexible neighbourhood workforce across social care and health, aligning pay, training, career paths, and recruitment, by implementing the Skills for Care workforce plan and legislating for social care workforce planning
- Embed social care expertise as standard within neighbourhood multidisciplinary teams.
A way forward we can take now
Local government and NHS staff see the human cost of fragmented care every day. People deserve services that understand their lives as a whole – not in slices. Social care workers deserve recognition as equal partners, not the last stop in a pressured system. Neighbourhood health and wellbeing integration is how we honour both.
We cannot wait for the Phase 2, long-term segment of the Casey Review or the next spending settlement to do this. The models exist now, and the best places are already using them. The year ahead will provide opportunities to make the policy changes that enable local reform. The question is whether leaders are prepared to act.
Integrated neighbourhood health and wellbeing is not something to wait for. It is something every system can already do to protect people, staff and the limited resources we have.
If the NHS and social care keep trying to solve the same problems separately, both will fail. But if we work as one neighbourhood system, we can make the money go further, and give people better care today.
Jess McGregor is president of the Association of Directors of Adult Social Services and executive director of adults and health at Camden LBC. Matthew Taylor is chief executive of the NHS Confederation.
