Newspaper headlines in the last two weeks have carried a number of stories about a funding crisis heading for the NHS. Common amongst these stories is the fact that they identify the transfer of NHS funding into social care as contributing to this ‘black hole’.
What is being referred to here is the creation of the ‘Integration Transformation Fund’ at the Spending Review in July 2013. Since then, it has gained the less technical title – the ‘Better Care Fund’ – in recognition of the Fund’s increased political importance.
Despite the change in title, the principle remains the same: this fund – totaling £3.8bn – is to be made available to Health and Well-being Boards to be spent on better social care for disabled and older people.
It is true that half of this money, £2bn, has been earmarked from the NHS Budget in a bold step that the Government has taken towards the hallowed ground of integrated health and social care services. It was a recognition of the obvious – that social care and hospital care are closely tied together, and we must start to think of them as such. An older or disabled person trapped in a hospital bed because they can’t get the support they need at home is perhaps the simplest illustration of how closely the systems are tied. Indeed, most patients just don’t know there is a difference in the first place.
As such, this £2bn doesn’t have to work hard for its place in the Fund. It’s important to remember that the Fund itself it not a straightforward ‘direct transfer’ from health budgets to social care. Health and Wellbeing Boards have to bid for this money – and there are tight national conditions attached. The most important of these conditions is that the money must be spent in a way that works for both social care and the NHS.
Another condition is that the money must be spent on care support that prevents unnecessary hospital admissions at the weekend.
In other words, by its very design, the Fund has to save the NHS money for it to even be allocated in the first place.
In both the NHS and in local authorities providing social care, there is considerable pressure to deliver more with fewer resources. With the core budgets of local authorities being cut by up to 40%, the social care landscape has had to adapt radically and quickly.
The Better Care Fund offers an incentive to both the NHS and to social care services to work together to innovate. It helps to lay the foundations for a much more integrated system of health and care.
And it must – by its very design – save the NHS money, not send it into financial ruin. If it’s not doing that yet, councils and health teams need to work harder together, not walk away. The government’s right – what’s at stake is better care.