A straw poll of London borough HR heads showed a mixed picture when it comes to cross-sector working with the NHS. Responses ranged from ‘we're working on a vision and implementation plan' to almost full integrated services. One HR head, admitting the culture challenge, talked about ‘challenging conversations' when it came to identifying which sector should be paying for care packages. Other barriers identified were pay differentials, pensions, culture and the patchwork quilt of hospital trust boundaries.

At the more advanced end of the scale one borough HR head said their area had an integrated mental health service and an integrated ‘virtual' organisation for health and care with a single point of contact for new referrals, and is expecting to move to a place-based model. Another said their borough had an integrated mental health service and had set up an independence and welfare training company but struggled with budgets. Again, budgets were cited as a problem for joined-up working, especially as the NHS can overspend and councils cannot.