Ministers want to extend NHS joint commissioning with councils to public health and children’s services, after being convinced by the better care fund planning process that the model will reap service improvements and financial benefits, LGC’s sister title Health Service Journal has been told.
It comes as the government announces today that health and wellbeing boards across England believe they will save more than £500m in 2015-16 because of the fund. Half of this is planned to come from a 3 per cent year on year reduction in the number of emergency admissions.
The better care fund plans have been produced during the past year and been rigorously assessed by a cross-departmental “taskforce” incorporating senior health and local government figures over the summer.
The plans are for 2015-16, the first full year of the fund, so are as yet untested. However the government is understood to be satisfied the approach has now proved itself as a concept, and should be adopted more widely.
HSJ has learned that Department of Health ministers believe the model should be applied to children’s services, which are currently commissioned by the NHS and councils with involvement from the Department of Education. Public health, which has primarily been the responsibility of local authorities since April 2013, should also increasingly be jointly commissioned with clinical commissioning groups, the DH believes.
The DH today confirmed the total national better care fund pool would be worth £5.3bn – greater than the minimum requirement of £3.8bn – because CCGs and councils had volunteered to place more into the fund.
The 2015-16 plans, totalled across England, suggest they will save £532m, of which £253m would come from a year on year reduction in emergency hospital admissions of 3.07 per cent.
The plans also set out to:
- cut the number of unnecessary days spent in hospital by 100,962, or 7.5 per cent;
- increase the number of people living independently rather than in a care home by 3.3 per cent; and
- increase the number of older people remaining at home at least three months after discharge from hospital by a third.
Under national better care fund guidance all areas are required to use the pooled budget to protect existing social care services; implement seven day services to support discharge; share data across health and social care and implement the use of the NHS number; and introduce joint health and social care assessments, and an accountable lead professional for vulnerable older people.
The DH also confirmed that five health and wellbeing boards’ better care fund plans have not been approved. Of the 146 that have been signed off, a third are “approved with conditions”, with the remainder either approved in full or “approved with support”.
Today’s announcement will form the first part of the government’s official response to the NHS Five Year Forward View, published last week by NHS England and the other national NHS bodies.
Subsequent installments of the government’s response will include announcements from health secretary Jeremy Hunt about the contribution of the NHS to the broader economy such as through life sciences; the need to become more efficient and innovative; and establishing a more accountable, patient centred culture.
The forward view document was relatively lukewarm about the better care fund, which it said should not be expanded without a full evaluation of its impact in 2015-16.
Foundation Trust Network policy and strategy director Saffron Cordery was sceptical about whether emergency admissions would fall in 2015-16. She said: “Since the start of this financial year, our members are experiencing unprecedented levels of emergency activity compared to previous years. This trend is likely to continue and even exacerbate in 2015-16 despite the introduction of initiatives funded through the better care fund.
“Change of this scale requires careful thought and financial flexibility so that local areas can run systems concurrently to protect patient safety as they move to new models of care.”
Health secretary Jeremy Hunt said: “The time for talk is over – our plans will make this vision a reality for patients and help deliver a sustainable future for the NHS.
“Too many families experience being passed from pillar to post, between the NHS and their council, endlessly repeating their stories along the way. By breaking down barriers within the system, these plans will allow staff to work together to prevent people from becoming ill in the first place, meaning our hospitals can focus on treating the patients who really need to be there.”