Integrated care: national policy and local experience

1. Integrated care: national policy and local experience Bobby Pratap National joint integrated care team (DH / DCLG / NHSE / LGA) Tuesday 14 July 2014

2. This presentation • Overview of national policy – why integrated care and why now? • Focus on the Better Care Fund – drivers and challenges • Local experience of integrated health and care • Personal view

3. DH-DCLG policy Better Care Fund Integrated care pioneers Removing the barriers to integrated health and social care

4. Better Care Fund Overview • Announced in June 2013 as part of the Spending Round • The NHS and Social Care will share £3.8bn in 2015/16 • Every CCG + LA has to jointly agree a spending plan for integrated care DH – Leading the nation’s health and care

5. Drivers for integrated care • “A lack of joined up care is one of the biggest frustrations for patients, service users and carers.” • “Getting it right will make a huge difference to quality, safety and people’s experience of care.” (Jeremy Taylor, CEO National Voices) Nuffield Trust: are health and care services changing to meet the needs of ‘Mrs Smith’?

6. Source: A narrative for person-centred coordinated (‘integrated’) care, National Voices http://www.nationalvoices.org.uk/sites/www.nationalvoices.org.uk/files/narrative-coordinated-care.pdf

7. Drivers for integrated care • Concern that Fractures in systems and delivery allow individuals to ‘fall through the gaps’ leading to poor experience and avoidable costs. • Optimism that integration can improve qualitywhile saving money (evidence from Torbay says ‘yes’ but benefits accrue over many years) • Financial Imperative: need for health and care to work together more efficiently in the context of a challenging Spending Review • Political Imperative: joined up care is a political issue with Labour proposals for fully integrated health and social care, Oldham Review etc. • Frustration about lack of progress and perceived failure of voluntary initiatives (pooled budget, care trusts etc.) to enter the mainstream

8. Drivers for integrated care • Social care transfer – 2010 Spending Round: • Social Care funding is not protected or ring-fenced (unlike NHS) • Funding requirement was expected to increase from c£16bn (2010) to £17bn by 2014 • Overall local government “spending power” was set to fall by 14% in real terms over four years. • Additional funding for social care – enough to allow authorities to protect adult social care if they choose to (still not ring fenced) • Includes NHS funding averaging ≈ £1bn per annum (with larger amounts each year) • DH / NHS spending on social care is still viewed as ‘health spend’ because care can benefit health. Giving health money to social care should also improve integration and partnership working

9. Drivers for integrated care • Integration transformation fund SR2013: • Faced with overall budget pressures authorities have still chosen to cut social care by broadly the same amount as other services. • Ultimately this means restrictions in services, increased care charges, and lower quality • Limited evidence of NHS funding being used on integration or prevention • Simple transfer of money is not enough to protect social care services (and therefore also protect health) • Need to go further to incentivise integration of services to secure sustainable improvements and efficiencies

10. The Better Care Fund: NHS and Councils will share£3.8bn of funding for integrated health and social care: Better Care Fund £3.8bn Shared between NHS and Local Government “Health Spending” DH DEL of £115bn BCF ≈ 3% Social Care spend of £17bn BCF ≈ 25% LG Spending Power of £50bn BCF ≈ 7.5%

11. How the BCF is funded (detail) The DH / NHS contributes £3.5bn of the BCF total – £1.9bn more than it is contributing to social care in 2014. Integration Transformation Fund

12. Every LA and CCG must agree a BCF spending plan Integration Transformation Fund

13. Reactions to the Better Care Fund… “The largest ever financial incentive for the NHS and Local Government to work together” Jeremy Hunt, Secretary of State for Health “Integrating £3.8 billion of a total NHS and social care budget of £120bn is depressingly unambitious” Liz Kendall, Shadow Minister for Older People “There is a fear the labels will be taken off the money and it will be used for filling in potholes” Sir Bruce Keogh, Medical Director at NHS England “It is robbing Peter to pay Paul […and could be…] either a catastrophe or a catalyst” Chris Hopson, Foundation Trust Network DH – Leading the nation’s health and care

14. Implementing the BCF – Policy Issues What a ‘pooled fund’ means in practice How can the money be genuinely shared between health and care? Pay-for-performance £1bn of the £3.8bn is to be paid on the basis of performance. How will this work? Legal framework Primary legislation is required to a create a pooled fund – late amendment to the Care Bill. Allocating funding At a national level there will be at least £3.8bn in pooled budgetsbut how is this determined locally? Ministerial assurance The SR agreed that ministers would sign-off local plans to ensure they were robust Relationships Getting the key stakeholders onside to help deliver the BCF Integration Transformation Fund

15. What a pooled fund means in practice Integration Transformation Fund

16. Pay for performance Integration Transformation Fund

17. The legal framework for the Fund Integration Transformation Fund

18. BCF local plans: developing and improving

19. Milestones and challenges for the next year INTEGRATION TRANSFORMATION Communications effort to support service change? Election Ministers sign off on plans Local, regional and national assurance of plans DIFFICULT RECONFIGURATIONS Support to areas struggling with P4P metrics Local Areas agreeing their plans Support to improve plans DH – Leading the nation’s health and care

20. Milestones and challenges for the next year The next Spending Review INTEGRATION TRANSFORMATION Communications effort to support service change? Election Ministers sign off on plans ? Local, regional and national assurance of plans DIFFICULT RECONFIGURATIONS Support to areas who fail P4P metrics Local Areas agreeing their plans Support to improve plans DH – Leading the nation’s health and care