According to reports last week, the introduction of the Better Care Fund (BCF) has been called into doubt.
A Cabinet Office review has raised concerns about the viability of the Fund and the lack of detail around how it will deliver long-term savings.
Health Minister Earl Howe denied delays telling the House of Lords that the Better Care Fund was 'broadly on track'.
Nevertheless it’s clear that a high-level debate is currently taking place, the outcome of which will profoundly impact what happens after the General Election in 2015.
This isn’t the first time that cynicism around the effectiveness of the BCF has been aired. The pooled budget of £3.8bn to implement integrated care at scale polarised reaction when it was first announced in June 2013.
Practical, and entirely understandable, questions were asked about where the money was to be pooled from and doubts were raised about the feasibility of the transformation needed to join up services in practice.
More recently, the concerns we hear from local service providers are around the extent to which acute providers have been engaged in the development of plans; whether there is sufficient funding in the system to run existing services, and develop the capacity needed to start to shift demand; the challenges of cutting fixed-costs, when reduction in demand might be slow and incremental; the strength of current relationships between primary, community, acute health providers and their local government colleagues, at all levels; a lack of public understanding of the severity of the crisis, and the need for more honesty in the debate.
The task now facing us, to better co-ordinate services centred on the needs of individuals and make huge financial efficiencies is mammoth, complex, and daunting. But it remains essential.
And, the logic underpinning the BCF remains robust – we need a pooled response to a shared crisis; health and local government must work together to build capacity in individuals and in the community; outcomes must improve; and demand must reduce.
The BCF plans are at their heart commissioning documents. They set out a series of joint intentions across health and local government for improving outcomes for individuals and communities in every locality across England; and through this process, building a sustainable future for key public services.
Significant investment has already gone into developing them and those on the frontline of commissioning and providing carearepositive about the clarity that BCF plans have brought.
Even if there are still gaps around how integrating care will work in practice, there is now alignment and consensus around local outcomes, resources and the choices ahead.
No one is claiming that the Better Care Fund offers a complete solution. However, it is a vital first step, setting the direction of travel and acting as a catalyst for change.
Working with commissioners, providers, and the communities they serve to address the complexities arising from the environment we find ourselves in today, may just help inch us in the right direction.
Claire Kennedy is co-founder and managing director at PPL
