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Analysis: Pooling arrangements remain at heart of integration plans

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The Conservative manifesto pledged to “integrate health and social care, through our better care fund”.

Despite both services facing similar pressures in terms of an ageing population and rising demand, the NHS was promised an additional £8bn a year by 2020 while commitments to provide adequate funding for social care were conspicuous by their absence.

Calls from the Local Government Association, Association of Directors of Adult Social Services and others for social care funding to be protected are unlikely to find favour with the Treasury.

However, before the election health secretary Jeremy Hunt, who remains in post, said councils could expect to benefit from the £8bn through an extended better care fund.

The fund took full effect at the beginning of 2015-16, creating pooled health and social care budgets under the joint oversight of councils and clinical commissioning groups via the transfer of more than £1.9bn of NHS funding.

It is expected that this money at least will continue to be available for social care in coming years but no figure has been put on how much extra could be pooled, if as Mr Hunt indicates the scheme continues and is expanded.

The rollout of the first stage of the fund became fraught with difficulties in implementation, despite early enthusiasm on both sides.

New communities secretary Greg Clark will need to get up to speed quickly if he is to fight local government’s corner in discussions with Mr Hunt, now three years into the job, and the well respected NHS chief executive Simon Stevens.

Although Mr Stevens has been an outspoken supporter of the need to protect social care – the £8bn he says the NHS needs is predicated on no further cuts to social care budgets – his priority will understandably be ensuring NHS performance and quality does not suffer.

Mr Clark is understood to be closer to Mr Osborne than his predecessor Eric Pickles, which could prove advantageous for local government in negotiations about the next stage of the better care fund.

The Conservative manifesto was the only one to commit to implementing the NHS Five Year Forward View which set out a number of new models of care which are being piloted in 29 areas around the country. A handful of these involve the local authority and social care services but most focus on vertical integration between NHS organisations. This means the BCF and health and wellbeing boards, with increased provider involvement, are likely to remain the focus for the joining up of health and social care.

Mr Clark may also need to be prepared for robust discussions with his health colleagues about whether to continue the public health ringfence beyond 2015-16.

While local government officials tend to believe the money could be better used if it was freed up, allowing councils to support a broader range of preventative services than currently permitted and support integration, NHS colleagues, particularly among providers are fearful the money is being used to plug holes in council spending plans.

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