1st April 2016
Siloed funding streams: An encumbrance to integrated care services
The desire to see the delivery of integrated healthcare and social care services is broadly shared by health professionals, government bodies and special interest groups. Nevertheless, in England, successful delivery to date can only be traced to local initiatives that focus on specific areas of care or patient groups. These successes are driven by joint working between local authorities and health trusts, plus third sector organisations, and are to be commended; not least, because they have generally been achieved despite national funding mechanisms working against them rather
than for them.
The Better Care Fund of £3.8bn was enhanced by additional voluntary contributions, bringing the Fund up to £5.3bn; it has helped to support a number of local initiatives and the CSR promised a further £1.5bn in the two years to March 2020. However, in a survey of local authority care directors by Health MJ and BT, almost half said they believe the Better Care Fund has had little or no impact on care budgets and service quality.
Last summer, the King’s Fund report, ‘Options for Integrated Commissioning’, added further weight to the argument for a single pooled budget in every local area by 2020. The paper recommended ceding control of the national budget for social care to the Department of Health. The think tank examined the financial viability of the health care system and determined that health and wellbeing boards are not fit for this role in their current form. The report suggested a single outcomes framework for an integrated system and legislation to enable health and wellbeing boards to take over health and social care commissioning.
Full integration of healthcare and social care would, on face value, appear to be the logical way forward. It’s not without precedent; Northern Ireland took that direct approach by bringing together services into five regional health and social care trusts. However, whilst reorganisation in various forms has been mooted, particularly by politicians in the lead up to the last election, significant reorganisation is unlikely to be embarked upon, given the turmoil created by the reforms instigated by Andrew Lansley. Furthermore, there are a number of major obstacles to full integration:
differentials in pay scales between the NHS and local authorities would force costs upwards and healthcare deficits would create further pressures on – and likely damage – other local authority services.
Health MJ and BT’s survey of local authority care directors also showed that they believe digital technology helps to deliver a better quality of life for users around a community-based service, whilst also helping to cope with budget pressures and rising demand. In its response to Simon Stevens’ Five Year Forward View, techUK launched its Interoperability Charter, setting out key principles for IT suppliers, the NHS, and Local Government to sign up to in order to deliver ‘radical service transformation’ through the co-operation, transparency, and adoption of interoperability standards. Shortly afterward, the ‘Newcastle Declaration’ was made by the CCIO Network of front-line clinical information leaders from across the NHS. This called for a ‘radical step change’ in information sharing between different electronic systems to ‘enable truly joined up health and social care’.
As a supplier of technology and services that support integrated healthcare and social care services, we welcome all initiatives that underpin closer working between care providers – and those between providers and suppliers – focussed on patient-centric service delivery. Having taken the more direct approach by creating regional health and social care trusts in Northern Ireland, the three largest now use a common Electronic Patient Record (EPR) system to support fully integrated community services. This is then complemented by the Electronic Care Record so that
information can be shared with clinicians and care workers in acute and other settings The provision of shared access to patient/client data and the implementation of common working processes is essential to upholding one of the guiding principles of the ‘eHealth and Care Strategy’ in the province: to make information available in the right place at the right time to support the best care.
Recognition of the fact that ‘siloed’ funding streams are an encumbrance to integrated care services has to translate into actions that bring these streams together. Northern Ireland has adopted one clear approach, the King’s Fund recommends another, and a single care budget will underpin Manchester’s devolution programme. With 37 local stakeholder organisations (as well as NHS England) to be represented on the strategic partnership board that will become operational next month, the opportunity is arriving in Greater Manchester to demonstrate that shared aims
and ambitious care transformation plans supported by a single budget can translate into significant improvements in outcomes for citizens.
By David Roots, Executive Director of Health and Social Care at Civica