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All commissioners should consider NHS and social care shared budgets, says Future Forum

12/01/12

The NHS Future Forum has said that all commissioners should be able to override current payment rules and share budgets with local authorities in order to accelerate service integration.

The forum published its second set of reports earlier in the week, which look specifically at integration, public health, education and training, and information. This follows its initial report which was published in June 2011 as part of the government’s ‘listening exercise’ on the health bill.

The report on integration sets out a series of deadlines and expectations to encourage more integrated care.

It says that all NHS commissioners and local authorities should consider shared budgets for some patient groups. It also argues for commissioners to be given the freedom and flexibility to vary tariffs and contracts, in a bid to aid integration while new funding models are developed.

Further, it calls for more detailed explanations of how NHS competition rules will work.

The report also warns the NHS Commissioning Board against an overly top-down approach, and criticises ‘structural change prescribed centrally’ for getting in the way of service integration.

The government has accepted all of the Future Forum’s recommendations, and Andrew Lansley is expected to announce that patient experience measures designed to reflect integration will be placed in the NHS outcomes framework.

The government is also expected to comment further on other recommendations.

The Forum’s report on integration was written by GP Robert Varnham and former local authority chief executive Geoff Alltimes. It says:

‘There was almost universal welcome for the current focus on integration in health and social care.

‘However, we saw and heard that it is currently too hard to make progress, particularly towards the huge gains promised by joint commissioning by the NHS and local government.

‘Enabling more patients to experience a smooth, effective and safe care journey is not simply a matter of trying harder – a number of changes in the system are necessary.’

The report goes further to raise concerns about the extent of local autonomy to develop integrated services and the current performance management ‘grip’ on the NHS. It says:

‘The greatest current challenge facing the NHS is the need to balance financial ‘grip’ with local ‘freedom’.

‘Frontline professionals and managers expressed a desire for greater freedom to design locally responsive services. However, they also described how innovation, clinical engagement and the development of locally sensitive services were stifled by a tendency towards centrally imposed change and micro-management.

‘We will watch with interest to see how the NHS Commissioning Board establishes a new way of working, which balances the imperative for local freedom and flexibility with the need to maintain financial control and sustainability.’