The legislation was developed at the national level and is linked to the previous Health Act 1999. Joint work and the application of legal flexibilities, such as the Section 75 Partnership Agreement, have been promoted by national political agendas such as world-class commissioning, “Strong and Prosperous Communities” (2006), “Our Health, Our Care, Our Right to Look” (2006), “Putting People First” (2007) and “Transforming Community Services” (2009). Integrated care structures have contributed to the evaluation of world-class commissioning (partnership is a key skill) that provides greater incentives for municipalities to establish common health and social security structures. Section 75 Partnership agreements, provided for by NHS Act 2006, allow for the pooling of budgets between health planners/providers and social providers, resources and management structures. Most NHS Trusts, care trusts and councils have a kind of bundled funding system, with pooled resources that account for about 3.4% of the total health and social services budget. It is widely accepted that the creation of a partnership agreement and the implementation of organizational changes are a complex and labour-intensive task, often leading to initial tensions in organizational cultures, while roles and responsibilities are redefined. However, demonstrating the efficiencies achieved through the establishment of uniform structures encourages a commitment to pooling budgets and establishing common structures. An example of efficiency gains created by common structures is in the City of Liverpool, where a single commissioning unit has been created through a Section 75 partnership agreement. The savings in the back office are estimated at around 1.5 million euros per year. These savings are the result of common systems and overheads used by the integrated unit team. The location of the team in common premises, a unique health computer system, a harmonized performance management system and indicators, and common results goals contribute to a more efficient and focused work practice.
Section 75 Partnership agreements under the NHS Act 2006 allow for the pooling of budgets between institutions and local health and social services authorities. Management resources and structures can be integrated and functions redistributed between partners. The legal mechanisms for pooling budgets (the Partnership Agreement under Section 75) should allow for greater integration between health care and social services and more locally-friendly services. Legal flexibility allows for a strategic and more effective approach to the commissioning of local services in all organizations and a basis for the establishment of new organizational structures integrating health and social services.