Is the Better Care Fund preventing integration rather than promoting it?
Good, collaborative relationships and whole system sign up are key to effective health and care integration, improved care outcomes and success for the Better Care Fund
As the latest Better Care Fund guidance hit the inboxes of CCGs and Local Authorities around the country, the collective groaning from across health and social care was almost audible.
While politicians from the major parties joust for position, the Better Care Fund is increasingly becoming more of a political football and a driver of real integration.
The problem is essentially a financial one. The NHS is short of money and councils have even less. Along came the Better Care Fund with its promise of money from health for social care. Cue panic in the NHS, followed by constant changes in the guidance making any transfer of funds less and less likely.
Richard Vize, writing in the Guardian recently, highlighted the impact of cultural differences on the Better Care Fund, ‘The cultural chasm between local government and the NHS should also not be underestimated. Accusations of a "lack of political nous" in the NHS were countered with suspicions that Better Care Fund plans were a subterfuge to get NHS cash into social care. In one area the council and the Trust were refusing to share budget data.’
The starting point is a very unhelpful vagueness about what is meant by integration. The Better Care Fund starts with money, and the pooling of budgets. But a recently published study by York University Centre for Health Economics shows that nowhere in the world have pooled budgets or integrated models of care produced better outcomes or lower costs.*
So we are attempting to pool budgets to reduce expenditure in health to use the savings to support social care, when there is no evidence that this works! Not much of a surprise, then, that those who stand to lose the most (the hospitals) have made so much noise, and by one means or another brought about the change that funding can only be released when actual savings are made.
The danger is the knock on effect. The imposition of the Better Care Fund and the threat of change, unacceptable to both parties, leads to the adoption of entrenched positions and a deterioration in local relationships between health and social care which in turn leads to less integration.
Good, collaborative relationships are key to making integration effective. Whilst the evidence shows that health and social care integration in much of the UK has not delivered better outcomes at lower costs, there is a small growth in the evidence that health and care systems working collaboratively can start to reduce the demand pressures on both social care and acute hospitals. But success requires effective collaboration and whole system sign up to improving outcomes in both areas.
So where should integration efforts be focussed? Is it better for health and social care commissioners to come together and set up joint commissioning units (or something similar), or should the time be spent on bring providers together to change the way that care is provided? If it is the out of hospital system that requires attention, unlocking the innovation potential of those working in the system seems to me the most likely to deliver results. If health and social care commissioners can agree to work through a co-ordinating provider, the chances of integration being effective are likely to be much higher.
The Better Care Fund started out with good intentions, but is now running the serious risk of making integration harder rather than easier. Local systems must agree what integration means for them, and put cultural differences aside to make this a reality. In practice this may mean commissioners getting out of the way, and allowing providers to organise care around individuals rather than institutions.
*‘Financial Mechanisms for integrating funds for health and social care – do they enable integrated care?’ Anne Mason, Maria Goddard, Helen Weatherly. Centre for Health Economics. University of York 2014.
Ben Gowland is the Chief Executive at NHS Nene CCG and formerly Director, Service Improvement and Quality, Croydon Health Services NHS Trust.
You may be interested to read SA Mathieson - The doctor will be rated by you now... Health and social care providers may be resistant to innovations that benefit patients, but they are making an exception for online feedback services
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.
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