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Better care funds need greater certainty

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“That would be an ecumenical matter”.

Father Ted gave Father Jack this line whenever he was asked a tricky question by the visiting bishop. 

For those involved with the better care fund this year, our version has been ‘local determination’. 

The government recently had to define what it meant by ‘social care’ in the same level of detail the NHS has defined ‘waiting list’.

The precise explanation of the contribution the better care fund would make to a council’s bottom line was that a good plan would “articulate what protecting adult social care services will look like in practical terms in your area, ie indicate own local definition”.

NHS England, however, has had no such fear of clarity. It has spent money on consultants to provide webinars and workshops leading right up to the deadline for handing in the plans for Treasury approval.

Colleagues who have a greater experience of the NHS tell me that this ‘A Good Thing’. It means that ministers are taking a keen interest. Should we therefore prepare ourselves for further changes in criteria as ministers’ involvement is directly felt? 

After their funding reduction of between 20% and 30%, there is limited sympathy from colleagues in local government as a mere £1.9bn is extracted from the protected £98bn total for NHS England.

Locally, we operate pooled budgets for mental health and learning disabilities, and joint management arrangements for Continuing Healthcare.  Each of these agreements is larger than our better care fund, yet neither has received a fraction of the national attention of their younger sibling.

So why the attention? It may be to do with the spectacle of Department of Health money swimming into the ken of Department for Communities & Local Government officials keen to maintain levels of council spending power.

What we are feeling on the ground is the compromise reached between these two departments at ministerial level. 

The compromise is captured as wanting the majority of the fund to be spent by local government with acute waiting lists still being protected. 

In the worst extremes, health and wellbeing boards may have to wait weeks until month-three figures have been validated before seeing what the levels of unplanned admissions were. 

Such uncertainty makes letting the necessary contracts with primary, social and community care for the preventative work a risky business. 

I propose a simple improvement to allow the plans for reducing admission enough time to make a difference: provide a two-year settlement for the better care funds and the powers for a health and wellbeing board to balance the fund over the two years.  

Richard Hornby was finance director at West Sussex CC until June. He is now chief finance officer at Coastal West Sussex CCG 
He tweets as @Nyesdad

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