Integrated care and the Better Care Fund – what’s it all about? Read on to find out.

There has been talk about closer working, seamless service provision and integration for years. Tired with the pace of progress, local authorities and health have now been required to do something about it. Health & Wellbeing Boards have had to draw up their Better Care Fund (BCF) plans and had to submit them to the Dept of Health in April 2014.

Where’s the money coming from?

The £3.8bn BCF was announced by the government in the 2013 spending round with the purpose of ensuring a transformation in the delivery of integrated health and social care.

The BCF provides funding in 2015-16 to be spent locally on ensuring a transformation in integrated health and social care. In 2014-15, an additional £200m is being transferred from the NHS to enable local areas to prepare for the Fund in 2015-16. This additional money will only be paid out to councils that have jointly agreed and signed off two-year plans for the Better Care Fund.

The £3.8bn BCF is not new money. It comes into effect in 2015-16 and will be created from:

  • funding that was due to transfer from health to adult social care anyway, as well as other money from NHS funding
  • CCG (clinical commissioning group) reablement funding
  • capital funding including the Disabled Facilities Grant (even though housing authorities will still have responsibility for the provision of adaptations, so the DFG will have to be passported on to them)
  • money based on existing funding in 2014-15 that is allocated across the health and wider care system. This will include Carers’ Break funding.

The Fund will be allocated to areas in 2015-16. A condition of accessing the money is that CCGs and councils must jointly agree plans for how the money will be spent, and these plans must meet certain requirements. National criteria relate to:

  • Admissions to long term care in residential and nursing homes
  • Effectiveness of reablement services
  • The level of delayed transfers to care
  • 7-days a week working to support patients being discharged
  • Avoidable emergency admissions
  • The quality of people’s experience
  • There also has to be better data sharing between health and social care, with everyone identified by their NHS number.

Each area can agree its own local priorities as well.

What is the BCF for?

The BCF is a single pooled budget to support health and social care services to work more closely together in local areas, while improving services and value for money, protecting and improving social care services by shifting resources from acute services into community and preventative settings. Ultimately, a more integrated way of working should deliver a better deal to people and communities, and ensure that money is used more effectively and efficiently.

The BCF aim to set in place a care system that:

  • Maintains a constant focus on long term quality of care and outcomes for patients and service users
  • Ensures fairness and equality behind decision making
  • Gives people choice and control over what happens to them and how they live their life
  • Increases self-sufficiency and independence, and reduces reliance on services where appropriate
  • Protects the sustainability of services for the future

What can the current system feel like now for patients and service users?

People do things to me without asking
I have to repeat myself a lot of times to different people – don’t they ever talk to each other?!
I don’t feel listened to
I never know when people are going to turn up, or who is going to come, or what they are going to do
I don’t know who is in charge of my care
I haven’t been asked what I want out of life and what I want from my care
I don’t know where to go or who to ask if I need more help when things start to go wrong
I don’t know how I can help myself get better or manage my condition

What will integrated care look like?

The term ‘integrated care’ has almost become jargon. National health charity, the King’s Fund, has created this short animation to help bring it to life.

The BCF in Hampshire

The five CCGs (Clinical Commissioning Groups) and Hampshire County Council are pooling a proportion of their funding to provide integrated health and social care services.

Hampshire County Council £7,942,000
NHS Fareham and Gosport CCG £10,876,000
NHS South Eastern Hampshire CCG £11,617,000
NHS North East Hampshire and Farnham CCG £9,086,000
NHS North Hampshire CCG £11,391,000
NHS West Hampshire CCG £29,845,000
TOTAL £80,757,000

What is going to happen in Hampshire, and when?

Activity in Hampshire will follow a phased implementation plan. The indicative schedule for jointly commissioning all ‘out of hospital’ care over the next five years is as follows.

Phase 1: 2014-16
Older people with longer term conditions, including older people with mental health needs, and carers

Phase 2: 2016-2018
Adults with long term conditions
People with learning disabilities
People with mental health needs
Adults who may require NHS Continuing Health Care

Phase 3: 2018
Young people in transition including those who require complex rehabilitation
Children who may require NHS Continuing Health Care

Given that the intention is to have a different range of services available in the community, so that the people who currently go to hospital won’t need to – of if they do, they won’t need to be there for so long – there is bound to be an impact on hospitals. Discussions are taking place with them, but the projections are that the number of hospital beds in Hampshire will reduce and then level out. However, future growth could be on the cards because of the ageing population and prevalence of long term conditions.

The Hampshire Health and Wellbeing Board is responsible for overseeing the delivery of the BCF plan.

Participation of the voluntary and community sector

Both social care and CCGs have talked about the importance of working with and involving the voluntary and community sector, in order to achieve the vision of a simple, seamless and “joined-up” health and care journey for people and communities. However, engagement with the sector in the development of the Hampshire BCF plan has not been strong thus far.

Yet if the emphasis is on intervention and prevention, reducing demand, supportive communities, self care, etc, then the VCS is a natural partner – both sectors have something to offer that the other needs.