Pooled budgets can lead to better care and support, but only if we build them around the needs of people who use services

By David Pearson, President of the Association of Directors of Adult Social Services

SCIE opinion – 27 March 2015

Image of David Pearson

‘Better Care’ hasn’t had the smoothest of rides so far. People are right to be sceptical about new initiatives on integrating health and social care. But maintaining the status quo isn’t an option, so let’s be ambitious. What can health and social care organisations do together to fill the widening gap between need and resources?

Recent announcements from Manchester to Gloucester are seeing more councils teaming up with local NHS bodies to share resources, underpinned by pooled budgets. We all know that traditionally, organisational boundaries have meant that health and social care have separately commissioned services for similar needs, which can result in fragmented budgets, silo working and confusion for end users.

People can end up interacting with a range of different professionals, often having to repeat the same information about their needs to multiple people; leading to frustration both for the person and for the professionals involved in their care.

How do we transform commissioning to make a range of coordinated services available to help people achieve best outcomes? Because commissioning should promote prevention and wellbeing, plus improve quality of life and reduce the need for crisis treatment, as well as reduce the need for care or support away from home.

A consortium of organisations are working together on an NHS England / Local Government Association-commissioned project, to produce some ‘how to’ guides, to support Better Care Fund implementation work in localities. ‘How to bring budgets together and use them to develop coordinated care provision’ covers pooling budgets, risk-sharing between commissioners, and selecting payment and contracting models. The guides are on the SCIE website.

Pooling budgets is complex territory but can help overcome the historic fragmentation of services and their structures. In Sheffield, for example, the council and NHS have agreed one of the biggest pooled funds (£280m in the first year), hoping it’ll grow to encompass the whole of the health and care spend across the city. The shared ambition between the City Council, the CCG, the acute trust and other partners, has built on work over several years to get support for people right first time. Importantly, Sheffield is engaging people who use services, throughout the journey towards a shared vision for Better Care.

The way that providers organise themselves to respond to this agenda is vitally important if integration is to improve people’s experiences of care services. Ultimately, the people who receive care and support don’t care who owns the budget or how it is constructed. They just want better, person-centred and co-ordinated care. If we keep this to the front of our minds, we can perhaps overcome the hurdles that stand in the way of integrated care experiences.

David Pearson is President of the Association of Directors of Adult Social Services, and Corporate Director, adult social care, health, and public protection, Nottinghamshire County Council.


How to’ guides on the SCIE website featuring BCF implementation support

The Association of Directors of Adult Social Services (ADASS)

SCIE’s integration resources