Future of accountability structures in health and care systems in England

The CSP has submitted its views on government proposals for how to progress the integration of health and care systems and services in England.

Workforce Development

Consultation on a Department of Health and Social Care integration white paper Joining up care for people, places and populations closed today.

It proposes ‘place boards’ – made up of partner organisations from all parts of the NHS, social care, councils - to pool resources, make decisions and plan jointly.

It also proposes changes to financial and governance systems that support sharing of costs and value of services across sectors. 

Explaining why it is relevant to the physiotherapy workforce, CSP policy head Rachel Newton said:

The proposals will inform accountability structures in health and care systems, which will be shaping decisions on what services are commissioned, how they are staffed, where they are located and how CSP members can influence these decisions.


Better integration within health and between the NHS, public health and social care has been an ambition of successive government for decades – to better meet people’s needs and to be most efficient in doing this. 

In England this has led to various policies, including for local devolution of budgets (for example in Greater Manchester), Better Care Fund, provider collaboratives and health and wellbeing boards. 

The goal of integration underpins the Health and Care Bill currently going through its final stages in parliament and the creation of integrated care systems in England.

Integration between primary and community sectors was also a specific commitment in the Long Term Plan and primary care networks are seen as a vehicle for this. 

CSP response

CSP evidence called for integrated workforce planning, so that one part of the system isn’t stripping another part of the system of its physio workforce. The CSP said this was a problem that has come to the fore with ‘siloed’ working between primary care networks and community services.

‘It raises the issue of chronic understaffing of physiotherapy and rehab services and the need to ensure that systems have the physio staff numbers to meet overall system needs,’ said Ms Newton.

As part of integrated workforce planning the CSP calls for investment in physio staff development on all grades - to create a pipeline for the future– for example to move into FCPs and advanced practice roles.  

CSP evidence also calls for modernisation of rehab provision – setting out how current siloed provision by condition and sector is both inefficient and detrimental to individuals – who increasingly have more than one condition - and need personalised and holistic care.

It calls for joined up planning and resourcing of rehab services to meet unmet need and address health inequity and the introduction of rehab prescriptions as part of hospital discharge.

What happens next? 

The government will respond to consultation responses later in 2022 and before the end of this year will publish an integrated standards roadmap. 

By spring 2023 all places and integrated care systems should have adopted integrated accountability structures and a new national set of outcomes and priorities will be published. 

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