Place based leaders to get the flexibility to deploy pooled budgets

Next in our series of blogs on the Integration White Paper, we look at the financial frameworks and incentives (section three of the paper) in place to facilitate integration of health and care services at place level.

The White Paper’s ambition is wherever possible, pooled and aligned budgets should be “routine and grow to support” more integrated models of care, eventually covering much of the funding for health and social care services at place level.

Pooling of budgets to support joint delivery of services is not new, with established ways of doing this through the Better Care Fund and section 75 of the 2006 NHS Act. However, it is recognised that these financial levers can sometimes present as barriers to integration, often cited as being overly complex. To address this, the Government  plans to review existing section 75 arrangements, with a view to streamlining the regulations for commissioners and providers across the NHS and local government to pool their budgets to achieve shared outcomes.

Guidance on the scope of pooled budgets is expected to be published in Spring 2023 to support the NHS and local authorities to go ‘further and faster’ on financial alignment and pooling.

The Government is keen to ensure there is sufficient flexibility to enable collaboration and integration, without mandating how this is achieved but the expectation is that funding should be pooled and aligned around pathways where the case for joined up care is ‘most pressing’.

Pooling arrangements, the paper explains will remain subject to both NHS and local authority leadership and NHS system and place leaders agreeing what constitutes a fair and appropriate contribution. The White Paper makes an interesting point that, “In some cases, particularly as arrangements at place mature, it may well make sense to put in place more formal pooling arrangements and we would expect the overall level of pooling to increase in the years ahead.”

The White Paper acknowledges that the Better Care Fund has been a catalyst for driving pooled budgets across the country, with many areas voluntarily pooling increasing contributions above the mandated minimum. In 2020-21, voluntary contributions totalled £3bn above the nationally mandated minimum – double the figure in 2015-16 when the programme first launched. The Department of Health and Social Care plans to set out the policy framework for the Better Care Fund from 2023, including how the programme will support implementation of the new approach to integration at place level.

There is also an ambition to build on the roll out of personal budgets and personal health budgets across health and social care as part of the commitment to give people choice and control over how their healthcare is planned and delivered.

The White Paper invites views on the following financial issues discussed here:

• How can we improve sharing of best practice regarding pooled or aligned budgets?
• What guidance would be helpful in enabling local partners to develop simplified and proportionate pooled or aligned budgets?
• What examples are there of effective pooling or alignment of resources to integrate care or work to improve outcomes? What were the critical success factors?
• What features of the current pooling regime (section 75) could be improved and how? Are there any barriers, regulatory or bureaucratic that would need to be addressed?

These proposals are welcome but it will require ICS leaders to work collaboratively with their counterparts at place level.