Councils and NHS bodies must work together to provide responsive services for people who need both health and social care. This report examines how they jointly fund such partnerships and the impact this has on adult service users.
There are a number of statutory and non-statutory options available to local bodies. These range from care trusts - wholly integrated health and social care organisations that provide and sometimes commission services - to aligned budgets, where information is exchanged and joint decisions taken while functions and money remain separate. The most commonly used formal arrangement is the pooling of functions and resources under section 75 of the NHS Act 2006. Pooled funds are mainly used for learning disability, community equipment and mental health services, but rarely for older people’s services. Formal joint expenditure accounts for a relatively small amount, 3.4 per cent in 2007/08, of total health and social care spend.
Joint financing arrangements are tailored to local circumstances. They can often be considered complex, raising questions of accountability and governance. Formal signed agreements that might provide clarification are not always in place, fully comprehensive or regularly reviewed. Local bodies often do not completely understand the arrangements and the rules governing them. Some have also been deterred by the perceived complexity of the technical requirements for pooled funds, although, once understood, they are less onerous than they may seem. Other barriers to integration include the differences between organisations’ information and finance processes, although these can be overcome.
A desire to improve service users’ experience often drives joint arrangements. Organisations can usually describe how they now work better together but often not how they have jointly improved user experience. Partnership agreements often fail to include quantifiable outcome measures, and partners rarely monitor them when they do. Analysis of the limited national data available suggests that formal partnership arrangements have had little or no impact on reducing the number of older people who fall and break their hip, or on the length of time they spend in hospital for some common conditions. The same is true for the length of time those with mental health needs stay in hospital.
The report recommends that local NHS bodies and councils should: review their current joint financing arrangements against the advice contained in this report to ensure that they are fit for purpose and use the most appropriate funding and legal framework; draw up written joint funding or partnership agreements, and regularly review these in light of performance and changing circumstances; set and monitor measurable outcomes for service users for all their partnership agreements; and develop clear and synchronised financial frameworks that cover, for example, budget-setting, governance, financial planning, financial timetables and risk-sharing.
The Department of Health should: identify a consistent set of outcome measures from the existing range available for health and social care, which directly relate to joint working; review the success of the NHS operating framework 2007/08 guidance in bringing the NHS planning timetable forward to facilitate effective joint working by identifying barriers and lessons learned from implementation; and further aid joint financing and integrated care arrangements by developing a model document for legal arrangements to assist in drawing up partnership agreements, and a robust and accurate method of assessing partnership working to measure primary care trusts’ performance for relevant World Class Commissioning competencies.