Claire Kennedy and Simon Morioka, managing directors at PPL, urge critics of the Better Care Fund to examine the arguments first. This article first appeared on the website and in the e-newsletter of National Health Executive. Thanks go to the editor, Adam Hewitt, for his kind permission to reproduce the article here.
A link to the original piece in NHE can be found here: http://www.nationalhealthexecutive.com/Comment/dont-jump-to-conclusions-look-at-the-bcf-facts
In the past week, there has been increasing public debate as to the value of the Better Care Fund.
On one side, the Better Care Fund has been put forward as a solution to one of the biggest problems facing the UK health economy today – that of rising levels of health and social care need, coupled with reducing resources to meet this need. On the other, the Better Care Fund is being seen as potentially undermining our hospitals by setting unrealistic expectations about what can be achieved in the coming year, by diverting resources which are needed to keep core hospital services running, and, ironically, by distracting people from focusing on better care.
Whilst it is right that there is discussion about the proposed solution, no-one is seriously denying that the underlying problem of rising demand, and finite resources, is both real and imminent.
Current frontline providers of health and care services are already at the sharp end of pressures within the health and care system. They are also potentially most affected by the pooling of health and social care funding, and the related, radical changes to ways in which services are delivered, which sit at the heart of the Better Care Fund. Whilst rarely disagreeing with the vision of better co-ordinated, patient-centred care closer to home, providers have been rightly sharing their concerns about the implications for these changes in practice – not least, whether they have been effectively engaged in the development work to-date, and whether resulting plans will deliver the required shift in activity away from our hospitals and care homes, in the timeframes needed.
We know that these are real concerns, often shared by both commissioners and providers alike. Concerns about whether there is sufficient funding in the system to run existing services, whilst building capacity elsewhere. Concerns about the challenges of taking out large amounts of resource from current provision, when reductions in demand might be slow and incremental. In addition, there are real risks in relationships between primary, community and acute health providers, and their local government colleagues, which are still developing. Against a background of public understanding about the severity of the crisis from 2015-16 onwards, there is arguably a need for more honesty in the debate.
No single tool could ever address this plethora of issues, but the Better Care Fund is, at least, providing a lightning rod to articulate the scale of the challenge honestly and to start to give practical context to local discussions. Attacking the Better Care Fund, however sophisticatedly, simply does not do justice to the problems it is trying to address, or the work that is going on in many areas using the Better Care Fund as a starting point for addressing these. What we need now is not a whole new set of initiatives, but recognition of the existing good (and development, where needed, of better) Better Care Fund plans.
The kinds of practical next steps that will start to unblock these conversations have to acknowledge the gap between aspiration and reality, and to recognise that these changes are complex, large-scale and costly, but are also necessary.
We know that we will still need hospitals in the future. Every successfully functioning system of integrated care in the world has a strong acute sector at its heart. What we need to understand in detail is what will stay the same in the short to medium term, what will change, and what transitional arrangements might be required, to ensure patients and service-users continue to receive the best possible care throughout. Without a clear and agreed view of what the risks are, what investment and transitional support is required, and a proper debate around how this can be funded, the danger is that legitimately voiced concerns become just another excuse for inaction – whilst the underlying quality and sustainability of our health and care system simply continues to deteriorate. This is as true of debates around the impact on primary, community and social care services as it is of acute hospitals.
The Better Care Fund plans are at their heart commissioning documents, which set out a series of joint intentions across health and local government for improving outcomes for individuals and communities, in each and every locality across England, and through this process, building a sustainable future for key public services. Their great power is that they recognise a truth that most working across health and local government (and especially most patients and service-users) have recognised for some time – that health and social services form part of a single network of support. They will thrive or sink together.
We know that the answers are complex, and fraught with difficult decisions around how we prioritise and plan. We know existing plans have been pulled together quickly, and many need work. But we also know that the only way we can start to move forward is by having honest conversations about what the future needs to look like from a provider, commissioner and patient perspective – and the Better Care Fund process is as good a starting point for this as any.
Claire Kennedy and Simon Morioka are co-founders of PPL, which is an independent consultancy working across the UK to support the development and implementation of integrated care. PPL, along with GE Healthcare Finnamore, powers the Integrating Care collaborative.