Call for evidence outcome

Section 75 call for evidence: summary of responses

Updated 3 December 2024

Background

The Department of Health and Social Care (DHSC) is committed to facilitating greater integration of health and social care services. Integrated commissioning, along with pooling and aligning budgets, can help reduce fragmentation of services and facilitate more joined-up care that better meets people’s needs. System leaders have informed us that arrangements to pool budgets and integrate care can be complex, which can hinder more ambitious models of integration. 

Integrated models of care and pooled budgets are principally delivered through 2 sets of provisions in the NHS Act 2006. Firstly, the joint working and pooled fund arrangements under sections 65Z5 and 65Z6 (inserted by section 71 of the Health and Care Act 2022). Secondly, the provisions relating to arrangements between NHS bodies and local authorities under section 75, which is the route through which the Better Care Fund (BCF) is delivered.

Summary

DHSC ran a call for evidence to find out what more can be done to support further integration of health and care services delivered through greater use of section 75 of the NHS Act 2006.

Specifically, we sought views on:

• whether its scope should be widened to include additional health-related functions of local authorities and NHS bodies, or to include additional public health functions delegated to local authorities and NHS bodies by the Secretary of State
• whether we should consider widening the scope of organisations that can enter into arrangements under the section
• any perceived barriers to the pooling of budgets, and whether (and, if so, how), the provisions within the regulations could be simplified to facilitate easier use and reduce the administrative burden on NHS bodies and local authorities
• how we could strengthen and/or simplify the governance of section 75 arrangements to further support the commissioning of integrated care services

The call for evidence ran from 15 September 2023 to 31 October 2023. Respondents could respond using the online survey linked from the call for evidence page on GOV.UK. Some respondents shared their views via written response documents or via email.

Respondents held a range of views, summarised below:

• respondents highlighted a need for improvements to section 75 and integration. Common areas of concern were strengthening relationships between organisations, effective governance and financial structures
• suggestions for improvements included improved data and information sharing, ensuring clear governance arrangements, simplifying the process and developing shared understandings of roles and responsibilities
• respondents reported that inclusion of more services in section 75 arrangements could support service improvement, care co-ordination for patients and integration of services
• respondents who did not support inclusion of more services noted that this could cause fragmentation, due to what was reported as the complex nature of these arrangements
• overall, respondents acknowledged that section 75 arrangements are valuable and support integration. There was general support for widening the range of organisations that can enter into these arrangements, with voluntary, community and social enterprise (VCSE) organisations being an important recommendation

Methodology

Format

The survey had 91 responses to the online survey and 14 written responses. The responses to the closed questions (where respondents could select their answer from a list of options on the online survey) have been included below in bullet point format.

As the 14 written responses were not submitted in the same format, they are not included in the tables but have been used in the analytical framework for the open-text questions, where respondents had the choice to leave additional comments. The responses that did not fit into themes have been used internally to inform policymaking and next steps.

Generalisability

The results only represent the views of those who completed the survey. Where we refer to the views of respondents, this cannot be taken to be representative of the views of all people in England.

The report presents summaries of common themes found in responses and not summaries of individual responses. This means that:

• some responses that had unique suggestions may not be reflected if they did not fit a common theme
• not all examples that fit into a common theme are reflected

Analysis

The online survey contained 30 closed questions. For some questions, the answer options were:

• strongly agree
• agree
• neither agree nor disagree
• disagree 
• strongly disagree

For other questions, the answer options were:

• yes
• no
• not sure

Respondents were also able to choose not to answer. In addition to this, there were 46 open-ended questions, where respondents were invited to share additional comments to each question.

Responses to the closed questions are presented in bullet point format.

Responses to the open-text questions were analysed through thematic analysis. Words and phrases from responses were then ‘coded’ and these codes were sorted into ‘themes’, which are listed in each question summary.

The quality assurance process included a separate DHSC analytical team reviewing each question’s analysis thoroughly, starting in the early phases of work. This was followed up with both random spot checking during the analysis period and a full review following completion of the work. 

As the total number of responses for this call for evidence is relatively low, many questions did not raise consistent themes across responses. Those questions are outlined in the question summaries below.

Caveats

The findings from the call for evidence are not necessarily representative of or endorsed by DHSC. They are based solely on the responses to the survey. 

Respondent characteristics

The breakdown of respondent type from the online survey is provided below.

Table 1: breakdown of respondent type from the online survey

Sector	Response totals	Response %
Social care provider	3	3%
Cross sector role	2	2%
I am employed by a national representative body for example a medical royal college or the local government association	9	10%
I am employed by a local authority or combined authority	25	27%
I am employed by a nation-wide charity or campaigning organisation	7	8%
Health sector	36	40%
VCSE sector	2	2%
Other	1	1%
Unanswered	6	7%
Total	91	100%

Note: percentages are rounded up, and therefore figures may not add up to exactly 100%. Respondents were not required to give a response to this question in the survey.

Findings by question

In your experience, to what extent do you agree or disagree that the current section 75 partnership arrangements allow effective commissioning of NHS functions and local authority health-related functions?

Summary of responses from the online survey:

• strongly agree: 10 (11%)
• agree: 40 (44%)
• neither agree nor disagree: 24 (26%)
• disagree: 16 (18%)
• strongly disagree: 1 (1%)
• total: 91 (100%)

Over half of respondents (55%) either strongly agreed or agreed that current section 75 partnership arrangements allow effective commissioning of NHS functions and local authority health-related functions.

70 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples.’

A common theme was that current section 75 partnership arrangements support effective commissioning, enabling more integrated service provision, promoting collaboration and partnership working between organisations.

Respondents also highlighted challenges. Financial issues, such as insufficient funding, disagreements over expenditure and the way certain budgets are set were reported as barriers to successful integration. Respondents also acknowledged the importance of strong relationships in the effectiveness of section 75 arrangements. However, they noted that these arrangements can be complex to establish due to differences in organisational culture and priorities, and that setting them up requires sufficient capacity within the organisations involved.

In your experience, to what extent do you agree or disagree that the use of section 75 arrangements supports closer integration and personalisation of health and care services?

Summary of responses from the online survey:

• strongly agree: 10 (11%)
• agree: 46 (51%)
• neither agree nor disagree: 24 (26%)
• disagree: 10 (11%)
• strongly disagree: 1 (1%)
• total: 91 (100%)

Most respondents (62%) either strongly agreed or agreed that the use of section 75 arrangements supports closer integration and personalisation of health and care services.

67 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples.’

Respondents highlighted that section 75 is an enabler for integration, noting that it supports a flexible and more efficient approach. Respondents also mentioned that it promotes multi-disciplinary working and facilitates more person-centred care.

Respondents also noted some barriers, such as the importance of relationships, strong leadership and the challenges those from different professions sometimes face working together. Respondents also noted financial barriers such as section 75 requiring significant financial investment and the disparity between contracting and procurement rules between organisations. Some respondents also stated that more integration at scale was needed for section 75 to support integrated care delivery.

In your experience, to what extent do you agree or disagree that section 75 arrangements have led to demonstrable improvements to the health and care services delivered to local communities?

Summary of responses from the online survey:

• strongly agree: 6 (7%)
• agree: 36 (40%)
• neither agree nor disagree: 38 (42%)
• disagree: 10 (11%)
• strongly disagree: 1 (1%)
• total: 91 (100%)

Around half of respondents (47%) either strongly agreed or agreed that section 75 has led to demonstrable improvements to health and care services delivered in local areas, with 42% saying that they neither agree nor disagree. 12% either disagreed or strongly disagreed with the statement.

68 respondents provided an answer to the open-text question:

‘Please explain your answer and provide any specific examples of section 75 arrangements that have led to improvements.’

Respondents agreed that section 75 supports integration and promotes collaboration, with many respondents detailing examples of their organisation’s good integration with others. Respondents also stated that the use of section 75 can improve efficiency by, for example, reducing duplication, as well as being able to facilitate improvements in service delivery, with one respondent using the example of reducing hospital length of stay and readmission.

Respondents again noted that section 75 arrangements depend on there being a willingness to work together and that arrangements work well where relationships are more mature and embedded.

In your experience are there any barriers that hinder further use of section 75 partnership arrangements for adults and children’s health and social care services in your area?

Summary of responses from the online survey:

• yes: 68 (75%)
• no: 4 (4%)
• not sure: 19 (21%)
• total: 91 (100%)

Most respondents (75%) said there are barriers to further use of section 75 arrangements.

77 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples.’

Respondents identified several barriers. This included a lack of aligned structures and strategy across organisations, including governance arrangements and geographical boundary issues. Financial issues were also brought up, such as insufficient funding, separate funding streams and short-term grants. Other barriers included:

• different charging and accounting regimes
• commissioning arrangements lacking clarity
• funding contracts being too short-term
• poor relationships between organisations

Can you suggest any changes to section 75 partnership arrangements that would strengthen joint delivery of health and social care services in your area?

Summary of responses from the online survey:

• yes: 64 (70%)
• no: 5 (5%)
• not sure: 22 (24%)
• total: 91 (100%)

Most respondents (70%) agreed they could suggest changes to section 75 arrangements that would strengthen joint delivery of health and social care services in their area.

70 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples.’

The top recommendations included:

• addressing financial and funding barriers, mostly through integrated funding and aligned budgets
• expanding the scope of organisations and partners eligible to be part of section 75
• developing a clear set of guidance and templates to standardise the documentation

We also identified many less frequent themes from respondents, including:

• improving data sharing through linked data sets
• ensuring transparency and clear governance arrangements
• promoting more flexibility in local agreements and clarifying the risks and/or benefits of sharing arrangements
• developing a shared understanding of roles and responsibilities
• improving the workforce’s capability and providing longer-term funding
• simplifying the overall process to make section 75 easier to use

Do you think the scope of section 75 arrangements should be expanded to include emergency ambulance services?

Summary of responses from the online survey:

• yes: 14 (15%)
• no: 23 (25%)
• not sure: 54 (59%)
• total: 91 (100%)

Most respondents (59%) were not sure whether the scope should be expanded to include emergency ambulances.

46 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples.’

Most respondents did not provide additional comments, indicating that they had insufficient knowledge to comment or could not see the benefits.

20 respondents provided an answer to the open-text question:

‘What are the benefits and risks of your suggested approach?’

Where benefits were noted, these were seen to be around supporting service improvement, integration and collaboration. Where risks were noted the most common theme was around financial risks.

Do you think the scope of section 75 arrangements should be expanded to include general surgery?

Summary of responses from the online survey:

• yes: 9 (10%)
• no: 25 (27%)
• not sure: 57 (63%)
• total: 91 (100%)

Most respondents (63%) were not sure whether the scope should be expanded to include general surgery.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include radiotherapy?

Summary of responses from the online survey:

• yes: 8 (9%)
• no: 29 (32%)
• not sure: 54 (59%)
• total: 91 (100%)

Over half of respondents (59%) were not sure whether the scope of section 75 arrangements should be expanded to include radiotherapy.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include termination of pregnancies?

Summary of responses from the online survey:

• yes: 8 (9%)
• no: 21 (23%)
• not sure: 62 (68%)
• total: 91 (100%)

Most respondents (68%) were not sure whether the scope of section 75 arrangements should be expanded to include termination of pregnancies.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include endoscopy?

Summary of responses from the online survey:

• yes: 9 (10%)
• no: 27 (30%)
• not sure: 55 (60%)
• total: 91 (100%)

Most respondents (60%) were not sure whether the scope of section 75 arrangements should be expanded to include endoscopy.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include class 4 laser treatments?

Summary of responses from the online survey:

• yes: 3 (3%)
• no: 25 (27%)
• not sure: 63 (69%)
• total: 91 (100%)

Most respondents (69%) were not sure whether the scope of section 75 arrangements should be expanded to include class 4 laser treatments.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include use of any other invasive treatments?

Summary of responses from the online survey:

• yes: 2 (2%)
• no: 21 (23%)
• not sure: 68 (75%)
• total: 91 (100%)

Three quarters of respondents (75%) were not sure whether section 75 arrangements should be expanded to include any other invasive treatments. Only 2% thought that it should.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include primary ophthalmic services (NHS opticians)?

Summary of responses from the online survey:

• yes: 15 (16%)
• no: 21 (23%)
• not sure: 55 (60%)
• total: 91 (100%)

Most (60%) respondents were not sure whether section 75 arrangements should be expanded to include NHS opticians.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include primary dental care and complex dental surgeries under invasive surgery (NHS dentistry)?

Summary of responses from the online survey:

• yes: 19 (21%)
• no: 18 (20%)
• not sure: 54 (59%)
• total: 91 (100%)

Over half of respondents (59%) were not sure if section 75 arrangements should be expanded to include primary NHS dental care.

Respondents did not raise a consistent theme across open-text questions.

Do you think the scope of section 75 arrangements should be expanded to include pharmaceutical services?

Summary of responses from the online survey:

• yes: 24 (26%)
• no: 18 (20%)
• not sure: 49 (54%)
• total: 91 (100%)

Over half of respondents (54%) were not sure whether the scope should be expanded to include pharmaceutical services. 26% of respondents said that it should be included.

33 respondents provided an answer to this open-text question, of which 23 provided additional comments:

‘Please explain your answer and provide specific examples.’

Respondents noted that including this function would facilitate more integrated working.

26 respondents provided an answer to this open-text question:

‘What are the benefits and risks of your suggested approach?’

Where benefits were discussed, this was most commonly around improving integration with joint commissioning and a more joined up approach.

From the following functions which, if any, do you think should be included in the section 75 arrangements?

Respondents were able to select multiple options.

Summary of responses from the online survey:

• conduct of research for advancing knowledge and understanding: 32 (35%)
• providing microbiological or other technical services: 17 (19%)
• vaccination, immunisation or screening services: 48 (53%)
• prevention, diagnosis or treatment of illness: 43 (47%)
• training: 40 (44%)
• info and advice: 47 (52%)
• services of any person or any facility: 30 (33%)
• none: 26 (29%)
• no response: 0 (0%)

Around half of respondents (53%) stated that vaccination, immunisation or screening services, and information and advice (52%) should be included in section 75 arrangements. Just under half of respondents (47%) supported the inclusion of prevention, diagnosis or treatment of illness, and training (44%) in section 75 arrangements. Around a third of respondents (35%) also supported including the conduct of research for advancing knowledge and understanding, and services of any person or facility (33%). Around a quarter of respondents (29%) said none should be included.

47 respondents provided an answer to the open-text question:

‘Please explain your response with specific examples of how this could lead to improved care.’

A common theme from responses was that the inclusion of the suggested functions would support collaboration and integration across organisations. Respondents also suggested that the inclusion of the suggested functions in section 75 arrangements would lead to improved efficiency of service delivery.

However, some respondents did not support the inclusion of functions, noting that inclusion could result in fragmentation of services.

19 respondents provided an answer to the open-text question:

‘Please explain the risks and/or benefits of any changes and any mitigation that may reduce risks.’

The benefits mentioned were the same as those described above.

From the following functions, which, if any, do you think should be included in the section 75 arrangements?

Respondents were able to select multiple options.

Summary of responses from the online survey:

• providing information and advice: 57 (63%)
• providing services for healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way): 58 (64%)
• providing services or facilities for the prevention, diagnosis or treatment of illness: 56 (62%)
• providing financial incentives to encourage individuals to adopt healthier lifestyles: 39 (43%)
• providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment: 52 (57%)
• providing or participating in the provision of training for persons working or seeking to work in the field of health improvement: 47 (52%)
• making available the services of any person or any facilities: 35 (38%)
• none: 24 (26%)
• no response: 0 (0%)

Over half of respondents were in favour of widening the scope of section 75 to include:

• providing services for healthy living
• providing information and advice
• providing services or facilities for the prevention, diagnosis or treatment of illness
• providing assistance

Around half of respondents supported the inclusion of providing or participating in the provision of training for persons working or seeking to work in the field of health improvement.

Approximately one quarter of respondents said that none of these functions should be included.

35 respondents provided an answer to the open-text question:

‘Please explain your response with specific examples of how this could lead to improved care.’

One common theme raised was that inclusion of the suggested functions would promote a healthier lifestyle and add more focus to prevention, population health management and better co-ordination of services.

However, respondents also noted that delivery of this would require increased capacity and more resource.

Respondents raised several less common themes, suggesting, for example, that inclusion would:

• provide a more holistic person-centred approach for patients
• help to reduce health inequalities
• result in greater flexibility locally to consider use of public health functions in future

Are there any other local authority health-related or NHS functions that you think should be included in section 75 arrangements?

Summary of responses from the online survey:

• yes: 23 (25%)
• no: 21 (23%)
• not sure: 47 (52%)
• total: 91 (100%)

Most respondents said they were either not sure or did not think that any other local authority health-related or NHS functions should be included in section 75 arrangements.

36 respondents provided an answer to the open-text question:

‘Please provide examples of why or how this would improve care provided.’

There were no common themes raised by respondents. Some respondents suggested functions related to:

• inclusion of the VCSE sector in section 75 arrangements
• public health services
• children’s services
• community health services

16 respondents provided an answer to the open-text question:

‘What are the risks or benefits of any suggested changes?’

The response rate for this open-text question was low, but the main theme raised by respondents was the potential for joint working to improve the health and wellbeing of patients.

Do you think we should widen the range of organisations that can enter into section 75 arrangements beyond NHS bodies and local authorities?

Summary of responses from the online survey:

• yes: 58 (64%)
• no: 13 (14%)
• not sure: 20 (22%)
• total: 91 (100%)

Most respondents (64%) said that section 75 should be widened to include organisations beyond NHS bodies and local authorities.

65 respondents provided an answer to the open-text question:

‘Please specify which additional organisations, if any, you think should be included for adult and children’s services and explain why.’

Many respondents stated that VCSE organisations should be able to enter section 75 arrangements. Other common suggestions included:

• housing services
• social care providers
• children and education services, including special educational needs and disability (SEND) services
• police and justice services

29 respondents provided an answer to the open-text question:

‘Please provide examples of why or how this would improve care provided.’

The main themes raised by respondents in response to this question were that the inclusion of these organisations would improve joined-up care and would improve prevention.

Risks were noted around changing the organisations that can enter into section 75 arrangements, focusing on the complexity of differing governance arrangements and financial risk.

27 respondents provided an answer to the open-text question:

‘What are the risks or benefits of any suggested changes?’

One common theme raised by respondents was the need for good governance arrangements and the risk of complexity. Some respondents also mentioned financial challenges across different organisations as a risk.

Do you think combined authorities should be included as bodies that can enter into section 75 arrangements for both local authority health-related functions and NHS functions?

Summary of responses from the online survey:

• yes: 44 (48%)
• no: 12 (13%)
• not sure: 35 (38%)
• total: 91 (100%)

Around half of respondents (48%) said that combined authorities should be included in section 75 partnership arrangements. Over a third of respondents said that they were not sure.

44 respondents provided an answer to the open-text question:

‘Please explain your answer and give examples with consideration of the risks or benefits.’

The most common theme mentioned by respondents was that inclusion of combined authorities in section 75 would ‘improve joint working’.

Some risks were mentioned, including the complexity of section 75 arrangements and financial issues.

Do you think any additional safeguards would be needed if we widened the scope of health-related functions?

Summary of responses from the online survey:

• yes: 48 (53%)
• no: 8 (9%)
• not sure: 35 (38%)
• total: 91 (100%)

Over half (53%) of respondents agreed that additional safeguards would be necessary if we expanded the scope of section 75 health-related functions.

51 respondents provided answers to the open-text question:

‘Please explain your answer with examples and consideration of the risks, mitigation and benefits.’

Frequently mentioned areas include the need for improved governance, particularly through better governance structures and greater transparency. Respondents also noted the need for funding and/or financial assurance along with better guidance and support (such as guidance on dispute resolution and standardised government templates).

Additional suggestions from a smaller group of respondents included:

• accountability
• clarifying the role of the Care Quality Commission (CQC)
• concerns about the risks of short-term section 75 agreements
• increased complexity
• prevention and equality
• better collaboration between partners

Do you think any additional safeguards would be needed if we widened the range of additional organisations?

Summary of responses from the online survey:

• yes: 56 (62%)
• no: 9 (10%)
• not sure: 26 (29%)
• total: 91 (100%)

Most respondents (62%) agreed that additional safeguards would be necessary if we widened the range of additional organisations that could enter into section 75 partnership arrangements.

56 respondents provided additional comments in response to the open-text question:

‘Please explain your answer with examples and consideration of the risks, mitigation and benefits.’

The most common theme identified in the answers was the need for proper governance and regulation. One respondent, for example, pointed out that widening the scope of services and organisations would require assurance that governance is appropriate in all organisations and that, where non-health bodies provide health services or vice versa, there must be robust governance on both sides. Other recurring themes were improved transparency and accountability arrangements and the need for thorough risk assessments, particularly regarding the financial risks of undertaking partnership arrangements with additional organisations.

Less common themes included:

• the need for guidance and support, particularly for dispute mechanisms and conflicts of interest management
• the risks of sharing data, with stronger safeguards needed
• the importance of clear reporting to avoid the duplication across partners
• the increased complexity of the process, making performance monitoring more difficult and raising the legal risks

Do you think any additional safeguards would be needed if combined authorities could enter into section 75 arrangements for both local authority health-related functions and NHS functions?

Summary of responses from the online survey:

• yes: 34 (37%)
• no: 10 (11%)
• not sure: 47 (52%)
• total: 91 (100%)

Just over half of respondents (52%) said they were unsure whether additional safeguards would be needed if combined authorities could enter section 75 arrangements. Over a third of respondents said that additional safeguards would be needed.

36 respondents provided an answer to the open-text question:

‘Please explain your answer with examples and consideration of the risks, mitigation and benefits.’

The main theme raised by respondents was around the need to ensure clear governance arrangements if combined authorities could enter section 75 arrangements. One less common theme mentioned was the need to improve national guidance.

Are there any changes we could make that would simplify the use of section 75 of the NHS Act 2006?

Summary of responses from the online survey:

• yes: 40 (44%)
• no: 7 (8%)
• not sure: 44 (48%)
• total: 91 (100%)

Less than half (44%) said there were changes that would simplify the use of section 75, while around half of respondents said they were not sure.

43 respondents provided an answer to the open-text question:

‘Please explain your answer and provide examples to support your response.’

The main theme raised by respondents was the need for good national guidance and support for developing section 75 arrangements. Respondents also said that there should be better governance and accountability of section 75.

Do you think we should introduce an explicit requirement for a section 75 partnership agreement to set out how it will lead to an improvement in the way the function is exercised?

Summary of responses from the online survey:

• yes: 43 (47%)
• no: 14 (15%)
• not sure: 34 (37%)
• total: 91 (100%)

Around half of respondents (47%) agreed that we should introduce an explicit requirement for a section 75 partnership agreement to set out how it will lead to an improvement in the way the function is exercised. Over a third of respondents said they were not sure.

47 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples.’

Where respondents provided additional comments, one of the themes raised was that governance procedures should be in place to provide oversight and challenge. Respondents often stated that they would expect the establishment of section 75 arrangements to include a clear understanding of the intended improvements.

Some respondents mentioned that there would be a need to be clear on what constitutes improvements and how they will be measured. Respondents also raised the need to retain local flexibility. One less common theme raised was that additional guidance, resources and templates would be more helpful than making it an explicit requirement.

Do you think we should introduce an explicit requirement for a section 75 partnership agreement to set out how it will help to deliver the integrated care system’s plans and strategies for the area in which it is situated?

Summary of responses from the online survey:

• yes: 43 (47%)
• no: 22 (24%)
• not sure: 26 (29%)
• total: 91 (100%)

Around half of respondents (47%) agreed that we should introduce an explicit requirement for a section 75 partnership agreement to set out how it will help to deliver the plans and strategies for the integrated care system (ICS) in whose area the section 75 agreement applies.

52 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples.’

The most common theme raised by respondents was the need to focus on a joined-up approach with partners. However, respondents also noted that section 75 arrangements should already be aligned with the ICS plans.

Respondents questioned whether making this an explicit requirement was needed or required. Some respondents stated that the proposal would add an administrative burden and could result in duplication of effort. Several respondents also stated that there was a risk of being too prescriptive and that there was a need to retain local flexibility.

Do you think we need to be clearer on the operation of section 75 joint committees, including membership and decisions that can be made?

Summary of responses from the online survey:

• yes: 47 (52%)
• no: 18 (20%)
• not sure: 26 (29%)
• total: 91 (100%)

Around half of respondents (52%) think that we need to be clearer on the operation of section 75 joint committees.

52 respondents provided an answer to the open-text question:

‘Please explain your answer and provide specific examples with consideration of the risks or benefits.’

One common theme raised by respondents was that there was a need to provide clearer guidance, including suggestions of showing ‘what good looks like’, and providing case studies or draft terms of reference.

However, respondents also raised the need to retain local flexibility and suggested that the proposal was too prescriptive and risks impacting that flexibility.

Do you think we should give clearer direction on the minimum outcomes, monitoring and reporting requirements that must be agreed, upon creation of a section 75 arrangement?

Summary of responses from the online survey:

• yes: 49 (54%)
• no: 18 (20%)
• not sure: 24 (26%)
• total: 91 (100%)

Around half (54%) agreed that we should give clearer direction on the minimum outcomes, monitoring and reporting requirements that must be agreed on creation of a section 75 arrangement.

46 respondents provided an answer to the open-text question:

‘Please explain your answer and provide examples.’

The most common themes were the need to retain local flexibility and the need for simplicity. Although many respondents supported clearer direction on minimum outcomes and monitoring, many suggested that this should be kept to a bare minimum and that local areas should be allowed to determine local outcomes, based on their population needs.

Some respondents also noted that further guidance and support would be helpful, rather than legislative changes.

Do you think current arrangements for section 75 offer sufficient transparency and accountability?

Summary of responses from the online survey:

• yes: 33 (36%)
• no: 29 (32%)
• not sure: 29 (32%)
• total: 91 (100%)

There was no consensus on this question. 36% of respondents agreed that section 75 offers sufficient transparency and accountability, 32% disagreed and 32% were not sure.

25 respondents provided an answer to the open-text question:

‘Can you suggest ways we can strengthen these?’

From those who provided comments, the most common theme was around reporting and accountability requirements, suggesting that there should be a framework clearly laying out roles and responsibilities. Other respondents suggested that integrated care boards (ICBs) should be held accountable for section 75.

15 respondents provided an answer to the open-text question:

‘Please explain your answer and provide some examples and a consideration of the risks or benefits.’

There were no further themes identified from these responses.

Are there any equalities impacts that you are aware of (including positive impacts) that we need to consider with any changes to section 75 arrangements?

Summary of responses from the online survey:

• yes: 20 (22%)
• no: 22 (24%)
• not sure: 49 (54%)
• total: 91 (100%)

Over half of respondents (54%) were not sure about any equalities impacts we should be aware of when making any changes to section 75 arrangements.

17 respondents provided an answer to the open-text question:

‘Please explain your answer and where possible provide some specific examples.’

Of those that provided an answer, the most common theme was respondents noting that section 75 would have a positive impact on equalities.

Next steps

The responses from the call for evidence will inform our next steps in the review of section 75 (NHS Act 2006).