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The integration of health and social care has long been sought as a means of easing pressure on squeezed NHS and local government budgets, in addition to improving services.Paradoxically, it is financial constraints that are being cited as a key driver in the disintegration of longstanding agreements that were supposed to bridge the divide between the two pillars of the public sector.A warning was voiced 12 months ago by Trafford MBC as its executive voted to end its section 75 agreement with Greater Manchester Mental Health Trust. The council believes it can save £332,000 per year by bringing in-house social care services for people with mental illness.Officers in a report highlighted ‘financial risks' posed by the model, under which the service was funded by the council, yet the trust made decisions over spending on care and support packages. Furthermore, Trafford had ‘limited ability to manage the risk of the delegated functions not being delivered'.Most strikingly, the report stated: ‘The current challenges experienced in Trafford are in keeping with those which have been documented at both a regional and a national level. This suggests that a delegated model may not be the best way of delivering integrated service.'The trend is not confined to England. Five authorities in Wales gave notice in March that they were to withdraw from the Gwent Frailty Partnership, effective from next year.Newport City Council, Monmouthshire CC, and Blaenau Gwent, Caerphilly and Torfaen CBCs formed the partnership with Aneurin Bevan University Health Board in 2011, aiming to support care users to remain living in their own homes. But costs have risen steadily over the lifetime of the agreement, totalling £19m by 2025-26, forecast to overspend budget by £106,000.Furthermore, a review commissioned by the councils found ‘significant variation across local authority areas in funding per person and uneven health board subsidisation'. There was ‘a lack of governance' and councils were left ‘investing financially in arrangements they have little control over or accountability for'.It is not just local government that is encountering issues. In one of the latest instances of partnerships collapsing, Torbay Council was given notice in April its section 75 agreement with Torbay and South Devon NHS Foundation Trust was to end after 21 years.As in Trafford, the arrangement saw some adult social care services in the area delivered by the NHS body, but it raised concerns over ‘ongoing suitability and viability', particularly regarding ‘risk for demand and cost growth residing solely with the trust'.While council leader David Thomas said he was ‘really disappointed' by the decision, he pointed out it would enable greater control. He added: ‘Although change brings challenges, it also offers the chance to shape services that reflect our vision for thriving communities where people prosper.'The trust said ‘no immediate decisions have been made about future delivery arrangements', but that it ‘remains fully committed to integrated working'.Trust chief executive Joe Teape said: ‘Serving notice allows us to take a careful and considered look at how our partnership arrangements are governed in the future.'Ben Evans, managing director for management consultancy IMPOWER's health sector, said that for councils, the fallout from fair funding and looming local government reorganisation (LGR) were the key ‘motivators of their financial thinking', while local health bodies face pressure from NHS England to balance their budgets.He added: ‘Both have got financial pressures. The real challenge is, although it's the same problem, frequently they are both approaching it from different directions.'While there were ‘friction points' between local government and the NHS, Evans said there is a desire for integration to be successful.‘What we see is genuine goodwill and positive energy to make things work, it needs to be the right structural environment.'Lincolnshire CC has given notice to end its section 75 agreement delivering adult mental health social care in March next year, 20 years after it began. Independent reviews commissioned by the council found ‘escalating financial pressures, limitations in data, reporting and forecasting and the need for stronger governance and assurance'.Executive director of adult care and community wellbeing, Martin Samuels told The MJ a key weakness of the model is that councils and health bodies had ‘very different ways of looking at the world'.He said: ‘There's a lot of logic to it – in theory it should work really well but in practice it doesn't. In areas where social work has been delegated, we have found the medical model has become dominant.'However, he believes integration could still be achieved through ‘different ways of working together, but not as a single team'.Samuels added: ‘It's a bit of a risk, but we think it will be a better way of doing things. There are not many places left where there are delegated teams.'He believes the clustering of Integrated Care Boards (ICBs) posed an obstacle to greater integration as arrangements would have to suit a larger number of bodies in a ‘one-size-fits-all' scenario. ‘The bigger the footprint, the more difficult it is to work in an integrated and collaborative way,' Samuels stated.While there was promise in integrated neighbourhood contracts, Samuels feels there is need for a return to local government and health bodies to share footprints, as has been the case in past decades.‘It had issues but on the whole it worked well,' he said. ‘You could do significant, impactful integrated working. Ultimately, it's about relationships and a sense of shared purpose.'Evans sees hope for the future: ‘LGR and changes to ICB footprints provide a good backdrop to explore whether this is the right moment to do something different. He said it required ‘consistency of direction of travel' and ‘having the confidence to step up'.‘There is scope to be innovative and positive on a bottom-up basis, where systems can work together to allocate smaller pots of money.'Samuels added: ‘There's enormous hope in the system with a Prime Minister who has an interest and understanding of social care.' Comment: Embedding the conditions for successful care collaboration

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HEALTH AND CARE INTEGRATION

The severed links in health and care integration

By Martin Ford | 06 August 2026

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