Let’s get together (or not)

The NHS and local government: kind of getting along. With thanks to Matt Buck (www.drawnalism.com - if you'd like to buy a cartoon or book him to draw an event).

The NHS and local government: kind of getting along. With thanks to Matt Buck (www.drawnalism.com – if you’d like to buy a cartoon or book him to draw an event).

The Guardian had a very interesting story this week, suggesting that the Cabinet Office is trying to put the breaks on the Better Care Fund.

This is an uncontroversial-sounding pot of money that is billed as being about helping the NHS and councils work together, in order to keep people out of hospitals by providing better care for them in their own homes.

The Better Care Fund sounds uncontroversial because there is no doubt that finding better ways to help frail, elderly people with lots of long-term conditions is something that the NHS needs to do. Both because existing A&E services are not terribly good at it, and because it costs an awful lot of money.

However, there are distinct suspicions in the NHS that councils – which have received no ‘protection’ at all from the government’s ‘austerity’ measures – will just use the money to fill holes in their budgets. And even if that doesn’t happen, there is remarkably little evidence to suggest that  ‘integrated care’ will work or make significant savings (‘there may be trouble ahead’, below).

Meanwhile, it’s worth spelling out just how significant the savings would have to be from the Better Care Fund to make it a good investment. The fund is supposed to start next year with £3.8 billion, with most of the money sliced out of NHS acute (hospital) budgets over two years.

What could that money buy, if it stayed in the NHS. The answer, according to the King’s Fund, which cited the fund as a significant factor in its doomy outlook for NHS finances last week (‘there is trouble ahead’, immediately below) is 15% of emergency admissions.

Or, to put it another way, to ‘break even’ in the crudest of terms, the Better Care Fund would have to stop a sixth of all the people admitted through A&E every year from going anywhere near a hospital.

The Guardian says the Cabinet Office is not convinched that the claims for the fund stack up, and that it wants more work done on the policy. But it’s hard to imagine what work could be done to deliver this outcome.

If the paper’s story is accurate, there are some encouraging features about it. We might have much more rational policy making if more ideas were expressed in terms of their opportunity cost.

On the other hand, there may be simpler explanations for the story coming out now. The King’s Fund and others are calling for money to be found be pump-prime significant change in the NHS and to keep “otherwise viable” trusts from falling over in the short term.

More money seems unlikely in the run up to the election; but one alternative to finding more money is to stop a significant sum from leeching out of the service in the first place. This may be what is really happening here.


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