More calls for funding to be devolved to place level

A report from NHS Clinical Commissioners - Clinical commissioning groups: transferring the legacy into learning - reflected on the experience of clinical commissioning groups over the last nine years as they prepare to hand over their statutory functions to the new ICBs.

The report made 11 recommendations for integrated care systems (ICSs), including continuing to invest in comprehensive engagement of primary care clinicians and facilitating place-based integration. Louise Patten (pictured), chief executive of commissioners’ representative body and director of the NHS Confederation’s ICS Network, said that CCGs should be proud of the work they had done in paving the way for the move to systems. ‘They demonstrated that clinicians and managers can work together in a way that enhances each other’s expertise and that a focus on quality can deliver better outcomes for patients if the clinical community is on board,’ she said.

The report called for systems to ‘delegate resources and decision-making powers as near to the patient as possible at a neighbourhood and place level, where the deeper understanding of the population sits’. It further suggested that primary care leaders should be supported to collaborate with public health directors at place to ‘reprioritise investment which best reduces health inequalities’.

There has been an increased focus on the role of place-based partnerships within integrated care systems. In February, Chris Ham, co-chair of the NHS Assembly and senior visiting fellow at the King’s Fund, also called for funding to be allocated to place level.

‘Funding should be allocated to ICSs on a population basis and not tied to specific deliverables,’ he wrote in Governing the health and care system in England, also published by the confederation. ‘In turn, ICSs should devolve funding to placed based partnerships with resources only being retained by the system when agreed by partners.’

He added: ‘The principle of maximum devolution of funding will enable those responsible for delivering care to decide how best to use resources to improve outcomes.’

The recent government white paper on integration has also recently set out one possible model for governance at the place level. Under the suggested ‘place board model’, the council and ICB would delegate functions and budgets to the board, with a single person accountable for the delivery of shared outcomes and plans.

The paper also anticipated an increase in the use of pooled and aligned budgets, which would eventually cover ‘much of funding for health and social care services at place level’.