In an interview with Public Finance Norman Lamb says that he has his sights on 2018, as the date by which all health and care spending will be pooled in England. He said:
I want the approach to evolve rather than having anything imposed. The only imposition is to say that we have got to get budgets pooled locally completely, and I’ve talked to a lot of people about this and I think we’ve come up with a neat solution to achieve the pooled budget without a national reorganisation, which nobody wants.
The Better Care Fund seems to me to be the sensible way of achieving that objective, to progressively increase the extent of the pooling, and as you do that I think you remove the perverse consequences of the gaming across the boundary between the two.
The Better Care Fund is planned to start next year with initial funding of £3.8 billion, although Norman said that he expected the amount of funding pooled to be ‘significantly bigger’ than that figure. In a footnote to the article, we learn that since the interview he had been proved correct; 146 of the 151 Better Care Fund plans have been approved with £5.3bn of funding pooled from NHS and local government budgets.
He expects the mechanisms to vary across the 151 Better Care Fund areas.
You say to local areas, “this is the objective, it’s got to be pooled by this date, you set about working out your way of doing it”.
I think different models will emerge, and I see no difficulty with that at all, I favour a more permissive NHS where different areas do things differently.
Some areas might chose to base it on clinical commissioning groups with local authority representation on that board, some areas may chose to do it under the auspices of the local authority and the health and wellbeing board.
* Mary Reid is a contributing editor on Lib Dem Voice. She was a councillor in Kingston upon Thames, where she is still very active with the local party, and is the Hon President of Kingston Lib Dems.
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4 Comments
A lot of people being provided with individuals medical records who are not medics?
Its interesting that the Government pie chart of spend lumps social care into ‘welfare’, making it look the highest area of spend. If social care was included in the health budget item, then that would be the largest. There are lies, dammed lies and statistics!
On the whole is seems to be a positive move, and Norman Lamb deserves credit for the progress made, but it does nothing to address the NHS funding gap because it is not new, or additional money.
The Kings Fund says “The Better Care Fund offers a real opportunity to address immediate pressures on services and lay foundations for a much more integrated system of health and care delivered at scale and pace. But it will create risks as well as opportunities. The £3.8 billion {a target which has been exceeded} is not new or additional money and commissioners will have to make important decisions about how the grant is used.
I’m all for local solutions, but there needs to be a bit more thought at a national level than this article indicates. First of all what is “all health and care spending”? Does public health count? How does children’s social care fit in – the focus is usually given to older people in these debates?
But more importantly this doesn’t solve the funding issue – there are two separate funding processes. eg Through council’s via government grant, council tax and business rates combining with NHS funding. Even if you can agree a day one split – who funds the growth? A pooled organisation can’t just demand more from council’s and taxpayers to fill the NHS funding gap. In my opinion a pooled budget can only work long term with a unified funding arrangement.