One of the weaknesses of the current rules is the cumbersome nature of setting up a Partnership Agreement under Section 75. Leaders point out that red tape can be demanding and that strong and committed management is needed to manage local communities through such restructuring processes. The White Paper of the Ministry of Health (2010) promises both the sustainability of existing partnership agreements and the simplification of the procedures necessary for the establishment of partnerships. Many of the results and efficiencies discussed in this example relate to new integrated management structures and services. The creation of a partnership contract under Article 75 is currently the process for setting up such services. However, feedback from stakeholders indicates that the process can be simplified and improved. In practical terms, the directors and administrators of the NHS and the City Council are directly responsible for setting up and developing partnership agreements. This involves an often lengthy process of local negotiations that culminates in a new legally binding partnership framework contract. Agreements can also be complex and require careful consideration in order to obtain clarification on accountability and governance framework. There is a broad consensus that establishing a partnership agreement and implementing organizational changes is a complex, labour-intensive task that often leads to initial tensions in organizational cultures, while roles and responsibilities are redefined.
However, demonstrating the efficiency gains achieved through the formation of individual structures encourages a commitment to the pooling of budgets and the creation of common structures. Apprenticeship services are the type of offer most often justified by the use of agreements under Section 75. Boards tend to host these services after the transfer of funds from NHS Trusts. However, there are several examples of integrated offerings locally tailored to older people, often in the form of multidisciplinary, community-based teams and equipment, managed by nurses. An example of efficiency improvements generated by common structures can be found in the City of Liverpool, where a single commissioning unit has been established with a Section 75 partnership contract. Back-office savings are estimated at around €1.5 million per year. These savings are the result of shared systems and overhead costs used by the integrated unit team. The team`s location in common premises, a single health informatics system, a single performance management system and coordinated indicators and common results objectives contribute to a more efficient and targeted working practice. The partnership agreements referred to in Section 75, provided for in the NHS Act 2006, allow budgets to be pooled between healthcare planners/providers and social service providers, resources and management structures can be integrated.
Most NHS trusts, care trusts and boards have some form of pooled funding agreements, with pooled funds accounting for around 3.4% of the total health and social services budget. The partnership agreements referred to in Section 75, provided for in the NHS Act 2006, allow budgets to be pooled between local health and welfare organisations and public authorities. Resources and management structures can be integrated and functions reprogrammed between partners. The legal mechanisms for pooling budgets (Section 75 Partnership Agreement) allow for greater integration between health care and social services and services that are more adapted to institutions. Legal flexibility allows for a strategic and probably more effective approach to the inter-agency mission of local services and provides a basis for the creation of new organizational structures integrating health and social care. . . .