Pooled budgets to increase under integration plan

The Department of Health and Social Care’s white paper on integration – Joining up care for people, places and populations ­– sets out proposals to deliver a more joined-up approach between the two sectors. There are already good examples of collaborative working, the paper said. But ‘this is far from the norm’ and many services continued to work in a ‘compartmentalised way’.

‘Better integration is vital to stop people falling into the gaps between health and social care,’ said health and social care secretary Sajid Javid (pictured). ‘Ensuring our health and care system work in unison will mean we can support hardworking staff, provide better care to patients and deliver value for the taxpayer.’

The focus for greater integration will be at the place level. Care will be more personalised and accessible and there will be better information sharing, supported by a single digital care record. And there will also be a single person at a local level accountable for the delivery of a shared plan and outcomes. (The HFMA has produced a short summary of the white paper's proposals.)

The government said that financial frameworks were essential for integrated care. But in practice they had often been a barrier to the delivery of more integrated approaches over the last decade, often requiring complex workarounds. And while pooled budgets, set up under section 75 of the NHS Act 2006, could overcome these problems, there is scope to update and simplify these mechanisms.

Local areas will have the flexibility to pool budgets or, less formally, to ‘align resources’. But there is a clear expectation that the overall level of pooling will increase in the years ahead.

The white paper said there were already many examples of areas using pooled budgets or the Better Care Fund to enable ambitious models of integration. ‘However, there are also examples of bureaucracy and conflict, which prevent pragmatic attempts to improve services,’ it said. The paper said that proposals in the Health and Social Care Bill would simplify the governance mechanisms around these arrangements and make it easier for local bodies to collaborate.

The Better Care Fund was judged to have been a success, with some £3bn of voluntary contributions pooled in 2020/21 above the nationally mandated minimum. The policy framework for the fund from 2023 will be set out later this year, including how it will support the new approach to integration at place level. There will also be a review of the legislation covering pooled budgets, although schemes will continue to be subject to both NHS and local authority partners agreeing contributions.

‘Wherever possible, pooled or aligned budgets should be routine and grow to support more integrated models of service delivery, eventually covering much of funding for health and social care services at place level,’ the white paper said.

Matthew Taylor, chief executive of the NHS Confederation stressed that integration was not new and had been happening for many years. But he welcomed the approach on structures and funding. ‘There have been rumours that the government was going to force mergers or pooled budgets as a way of appointing a single accountable person, who would be responsible for planning health and care services in each local area,’ he said. ‘We are glad that the government has resisted this approach as it would have led to needless disruption at a time when the NHS needs to focus on recovering services as quickly as possible.’

NHS Providers said the proposals provided some ‘helpful, long-term thinking’ on how to develop integration, but extensive consultation and collaboration on solutions would be needed before they could be taken forward. It welcomed the proposed flexibility for places to decide governance arrangements and leadership models.

'However, we still have significant concerns about the proposal for a single accountable person in each place. This could further complicate lines of responsibility in already complex, developing system working structures,’ said the organisation’s deputy chief executive Saffron Cordery. ‘And while pooled budgets can help align decision-making across the NHS and social care, here again, we support a flexible approach. Pooling NHS and social care budgets is no substitute for funding both systems appropriately and placing social care services on a sustainable footing.’

She added that greater weight should be given to behavioural, relational and cultural factors in supporting local integration, rather than the current focus on structures and funding mechanisms.

The HFMA has published a number of briefings this week to support the move to integrated care systems:

Integrated care system finance and governance guidance map

Integrated care boards: finance policies and procedures

CCG closedown: maintaining corporate memory

Provisions and accruals: the impact of the Health and Care Bill on CCGs