Care integration key to closing NHS efficiency gap, says TDA boss

1 Oct 15

Much of the £22bn efficiency savings projected in the NHS Five Year Forward View is expected to come from the successful integration of health and social care services, a senior NHS figure has said.

Speaking at an integration summit organised yesterday by CIPFA and the Healthcare Financial Management Association yesterday, Bob Alexander, chief executive of the NHS Trust Development Authority, said this put some pressure onto the implementation of integration.

NHS England’s Five Year Forward View identified a £30bn shortfall by 2020/21 and called for £8bn of additional funding and a £22bn efficiency improvement

The government has since confirmed that it will provide the additional funding by the end of the parliament, and Alexander said this was now the only certain part of the plan.

“I’m telling you now, a big slug of the £22bn is expected to arrive out of integrated care of one form or another, and that is cash cost [savings],” he told delegates.

“The only thing we know is certain is £8bn,” he added. “The £30bn [total funding gap] was modelled, the £22bn was modelled, the £8bn was an ask.”

Now it was down to the NHS to “get on with it”, Alexander said.

“And that puts some pressure, I think, onto the Five Year Forward View implementation.”

There are successful examples of care integration at individual service level, such as diabetes care. However, there was now an expectation around projects such as the Better Care Fund and the vanguard projects to lead integration.

Terry Willows, deputy programme director of the Better Care Fund, told the conference it was likely the mandatory amount of pooling in the scheme would remain at £3.8bn in 2016/17.

He told delegates the main focus on the 151 BCF plans in the current year was on developing integrated care solutions, supporting reablement and increasing care at home. The highest proportion of investment was going to schemes with an intermediate or integrated care element.

Through their plans, areas have chosen to pool £5.3bn, significantly more than the minimum required.

It was likely, though, the baseline level would remain unchanged in 2016/17, Willows said, subject to confirmation in the Spending Review on November 25.

He added that discussions were ongoing about how the policy would relate to other areas of NHS reforms, and there was a commitment between national partners to ensure better alignment of any BCF planning process for 2016/17 with other core NHS planning processes.

“There will be a Better Care Fund this year and the year after. Ministers have agreed that. What we’re doing at the moment is trying to work through with ministers what the policy framework around the Better Care Fund will be.

“I think we can broadly say that it will be around the same size as now, but at the same time we will be sending really strong signals to areas that this is the minimum mandatory amount and we are thinking about ways in which we can incentivise areas to pool more than that minimum.”

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