By Vivienne Russell | 11 April 2013
The King’s Fund has warned that the critical issues of how and where NHS funds are allocated are being overlooked in the heated debates over the wider health service reforms.
In a report published today it says the changes to the NHS funding system make it ‘strikingly more fragmented’ and risk creating ‘confusion and complexity’. They could also undermine the government’s ambition to provide more integrated care.
‘As the reforms begin to be implemented, giving greater decision-making power to local bodies, and as health funding growth grinds to a halt, key stakeholders including the public are likely to want answers to pressing questions such as “Why does my area get X amount while the area next to us gets Y?” ’
The report examines how the reforms would affect the way funding is divided between the new Clinical Commissioning Groups and local authorities, which take on responsibility for public health. NHS England has been set up at arm’s length from the Department of Health to determine each body’s allocation.
The King’s Fund calls for a strategic and long-term assessment of the aims and methods of NHS resource allocation. It welcomes NHS England’s review of allocation, announced in December, as a first step.
But it adds: ‘We argue that it needs to go further, and provide a more fundamental reassessment of the objectives, processes and methods of health resource allocation in England. In doing so, it must address two key questions. Should resource allocation be a neutral way of allocating funds to the NHS and local government? Or a policy tool to support the NHS in delivering its mandate and changes to the wider system?’
The review should also explore how allocations ‘could be used to support alternative visions for the future of the NHS: clinically led, driven by outcomes, more integrated and provider led, or more integrated with other services through a “single budget” ’.
King’s Fund senior fellow David Buck said: ‘Recent reforms bring major changes to resource allocation, risking confusion and complexity. As the funding squeeze bites, it is crucial that we think carefully about how and why health spending is allocated. NHS England’s fundamental review is an opportunity for much-needed debate about what we hope to achieve through that funding in future.’
