Building trust: bringing budgets together to develop coordinated care

Moving forward to a new way of working together

Person-centred, integrated care requires new ways of working across organisations and between system leaders. Over recent years, great progress has been made to jointly fund, co-commission and deliver new models of care. A key lesson has been learned: successful initiatives are anchored in a common vision, narrative and set of objectives, co-created by the whole system – leaders, operational managers, clinical and frontline staff, service users and communities.

The common vision should set out what people want and need.

In other words, people’s own narratives should be at the centre of defining outcomes. Outcomes should reflect the philosophy, overall aims and mission of that ‘narrative’. The narrative for person-centred coordinated care and accompanying ‘I-statements’, developed by National Voices, help to define goals from a user-based perspective. See also How to… lead and manage better care and How to… understand and measure impact.

Having an integrated commissioning system allows us to begin to shape and mould the whole system around the individual.

Jake Rollin, Strategic Lead for Care and Independence, North East Lincolnshire CCG

Developing strong foundations may seem self-evident, but is often ignored when the focus shifts to immediate delivery. Engaging widely to develop, review and refresh outcomes and goals will:

Creating a shared vision, objectives and language

Time spent on developing a shared vision will pay dividends later on. Providers should remember to do the following:

Building a strong business case to overcome financial barriers across organisations

Managing finances in health and care is tied to formal lines of accountability and statutory responsibilities. With their different governance systems, we know that joint budgeting and whole-system financial approaches can be complex to develop. However, such approaches are adapting to the need to deliver population health and care in a joined-up way, and local solutions are being developed rapidly. Many CCGs and local authorities have established joint commissioning functions to respond to the pooled funding offered by the Better Care Fund, and the introduction of STPs and ICSs across larger footprints is encouraging such approaches to be scaled up.

Bringing budgets together requires a strong business case, with:

Forming strong relationships across organisations and at all organisational levels

Although the technical details of funding arrangements are important, relationships between individuals and teams are key to enabling joint commissioning to function effectively. The King’s Fund report, Options for Integrated Commissioning: Beyond Barker examines how collaborative partnerships, such as Health and Wellbeing Boards, can facilitate joint commissioning arrangements.

Although local government and NHS staff can share similar values, it is important to recognise that their organisations work in different ways. In addition to cultural differences between the sectors, local government is accountable to locally elected members, whereas the NHS is accountable to national organisations and politicians. This means that the responses of people working in local government can be different to those of people working in an NHS organisation.

Both parties need to be aware of these differences and work together to develop joint commissioning relationships despite the challenges. Further information on how to make joint working a success is included in How to... work together to achieve better joined-up care.

In the integrated world, the key is to get the best value for the public pound, and that’s a cross-organisational aim. Finance staff should be driven by, and support, what’s good for the whole health and social care system rather than what’s good for their organisation alone. They should be enablers, not blockers. They should help empower change through participative budgeting; a focus on outcomes; transparent presentation of the long-term effect of decisions; and should encourage, not discourage, the taking of appropriate risks. For example, the right thing may be to invest in new models of care that may not yet have a strong evidence base – because, in the face of current pressures, the risk of doing nothing is greater.

Rob Whiteman CIPFA, Chief Executive, CIPFA

How to... bring budgets together and use them to develop coordinated care provision
Previous section | All sections | Next section