By Richard Johnstone | 29 January 2015
Health and social care integration must eventually be expanded to cover all public spending for these services, rather than just applying to the £5.3bn pooled in the Better Care Fund, former health secretary Stephen Dorrell has said.
Speaking to Public Finance following an integration seminar hosted by CIPFA in Westminster yesterday, Dorrell, who was Conservative health secretary from 1995 to 1997, said the BCF did not represent a silver bullet to integration, but was a step in the right direction.
‘What the system is learning to do is take money from health and care budgets separately and delivering a more joined-up health and care system,’ he told PF.
However, he said different approaches would be devolved in different parts of the country as more money was pooled, he said.
‘There is no single easy answer of, “do this and everything will be ok”, but what we definitely need in my view is more joined-up commissioning, action to address perverse incentives in the system and engagement with the people who deliver the service.
‘The health and care budget isn’t what is in the Better Care Fund, it is the £125bn that is spent on health and care. We shouldn’t be limiting the pooling to a small sub-section of these budgets, we should be applying the logic to all of them.’
Dorrell, who also chaired the House of Commons’ health select committee from 2010 to 2014, said all the mechanisms that would eventually lead to full integration were not yet in place.
Speaking after the Labour Party set out plans for a new Year of Care NHS payment tariff to cover a patient’s care needs as part of an integration plan, he added this could form part of the necessary changes.
‘It’s not a new idea, and I think it is an important element of the answer but it is not a silver bullet,’ he said.
‘The truth is there is a whole series of practices that have grown up which apply tariff in a flexible way and I think that needs to be developed.
‘I’m not in favour of any attempt to determine from the centre remuneration for individual providers that excludes local flexibility. We have already moved in reality to a world where the tariff is applied flexibility and I think that logic has quite a way further to go.’
At the event, Dorrell said the reason integration had not yet happened was that there were perverse incentives in the current system, including payments rules.
‘It is why, although I’m certainly not a strong devotee of the [Health and Social Care] 2012 Act, one of the changes that I think will stand the test of time is the creation of health and wellbeing boards [which developed local BCF plans]. ‘They are not the finished article, but for the first time it is the beginnings of an institution that looks across traditional silos and can be the focus of pooling to address some of these perverse incentives.’
Also speaking at the event, Andrew Webster, director of integrated care at the Local Government Association and a member of the BCF leadership team, said the flagship reform was intended to help create a sustainable model of health and care.
Government changes to the scheme last July led to a stronger national assurance process for the plans, he added.
‘That oversight has now just about concluded, so we are now at a position where 120 of the 150 areas have got an approved plan, and the other areas will have one by March.
‘We can say that overall those plans propose to reduce admissions by 3%, to reduce 150,000 hospital attendances, support 200,000 people to stay at home who otherwise would have gone into a institutional setting, and get 100,000 people out of hospital quicker than they otherwise would have done. Those are pretty good outcomes.’
However, CIPFA chief executive Rob Whiteman warned delegates that ‘putting two lots of spending pressures together’ from the health service and local government wouldn’t necessarily save money.
‘The narrative at the moment that somehow integration will save money – I think intellectually, just the promise of that, one has to question from the point of view of the maths involved,’ he said.
‘I’m very, very keen on integration, and therefore I think the Better Care Fund and integration between health and social care is very important, but I also would say let’s not create a new silo where we see that in isolation to the rest of the public sector, and the rest of the services that need to be integrated.’
