MHP Health has published ‘All in this Together?’, investigating how councils are using the Better Care Fund.
Integration is at the top of politicians’ and policymakers’ health to-do-lists. Everyone is talking about it. From Norman Lamb’s integration pioneers, to Andy Burnham’s Whole Person Care Innovation Councils to Jeremy Hunt’s accountable GP for older people, a scrap is on in the build up to the next election for the party that can offer the most seamless, high quality care for patients.
However, how this political rhetoric is translating into on the ground service change remains subject to significant local variation and presents difficulties for those engaging with the system to translate into effective business strategies and positions.
Indeed whilst the integration narrative has been warmly welcomed by most in the health and social care sector, the realities of how it plays out in practice will almost certainly result in winners and losers emerging:
- Which services will be cut?
- Which services will be spared?
- What will the core tests be for commissioners to commission new services?
- Which conditions will be prioritised?
- What will happen to specialist centres?
- What will be the impact of bringing together two very different cultures on decision making?
- Where will innovative treatments and medicines fit in the new models of care being developed?
- Will the new landscape finally lead to a greater focus on prevention?
The Better Care Fund, the Government’s £3.8bn pot of money to drive integration in 2015-16, is the opportunity to highlight that progress is being made. The Fund itself has largely been welcomed, but challenges with it are clear and were recognised with the news last week that it may be delayed and with the acute sector continuing to stress that this is not new money (and that a significant proportion of it is being taken from their pockets).
In order to assess whether the new Fund will be effective, an assessment needs to be undertaken of how existing health to social care transfers have been spent.
MHP Health, supported by a foreword from the Care and Suppirt Alliance, has today published findings from an extensive audit of how this money has been allocated across 2012-13 and 2013-14. The report reveals that:
- Local authorities allocated £349m across the two years to maintaining eligibility criteria aimed at ensuring access to existing services. Money allocated to maintaining service eligibility was higher than any other category of spend in each year, 23% in 2012-13 and 24% in 2013-14
- Less than 4% of the funding transfer was allocated towardsmental health services in 2012-13 and 2013-14 combined – this despite the fact that achieving parity of esteem between mental and physical health is a priority for NHS and social care services
- Services aimed at helping people recover following periods of hospitalisation are also an identified priority of councils with £1 in every £5 allocated through the transfer funding across 2012-13 and 2013-14 aimed at improving patient recovery and early hospital discharge
The findings have significant implications for the Better Care Fund, half of which is due be financed through a transfer of funds from health to social care – the same money audited by this research. Current practice suggests that, in the absence of evidence about effective interventions that support integration and in light of current funding challenges for social care, the funding will be used to meet rising social care needs rather than transform services.