Mandatory budget pooling with councils will improve care outside hospital, local commissioning leaders believe. However, they believe it is likely to mean NHS funds are used by councils to subsidise their non-health functions and could damage quality in hospitals.

The HSJ clinical commissioning group leader barometer survey, carried out with Marie Curie Cancer Care, reveals more than eight in 10 respondents believe pooled budgets will mean their funding helps to pay for councils’ services outside of health and care.

The pooled budget initiative was announced by the government in July and will see £3.8bn of NHS funding shared between CCGs and local authorities in 2015-16. It is unclear exactly who will hold the money and how it will be controlled.

A smaller sum will be shared in 2014-15 and local commissioners have already been told to start planning for both years.

Of the 101 CCG leaders from 85 CCGs surveyed by HSJ and Marie Curie, there was widespread enthusiasm for the pooled budget creating better integrated services, which 83 per cent said would be a likely outcome. Eighty-two per cent also said it was likely it would improve out of hospital services.

However, only 45 per cent believed it would reduce demand for hospital services, and 38 per cent said it would create political support for hospital service reconfiguration - both aims of NHS leaders supporting the policy.

A third of respondents said the fund, which is likely to have to be paid for by significant disinvestment in acute care, was likely to harm quality in hospital.

A chief officer of a CCG in the north of England said: “The pooling is fine, it’s creating the cash for the local authority that’s wrong.

“We all know we need to grow care out of hospital and change hospital provision. This reduces our financial flexibility to pump prime change.”

A Midlands CCG chair said it was “difficult to see any substantial money pouring in when councils are strapped [for] money”.

Bassetlaw CCG chair Steve Kell, a co-chair of the NHS Clinical Commissioners leadership group, said: “The integration transformation fund is a real concern for hospitals, especially while local government is struggling with the need to make its own cuts.

“It’s essential that CCGs play an active part in making sure the fund actually benefits the NHS and patients. We are already seeing changes to public health budgets [which were transferred to councils in April] which will effect health budgets. It’s essential this doesn’t go the same way.”

The survey revealed enthusiasm for shifting funding to primary and community services as a national priority.

Questioned about solutions to problems with the emergency care system, the most popular suggestion was to expand services outside hospital, which 87 per cent said was likely to help.

Asked about challenges to allowing more people to die at home, the most commonly cited was a lack of 24/7 services in the community, which 67 per cent of respondents said posed a major challenge.

However, the survey demonstrates CCG leaders’ concerns that competition rules and regulation could make service change difficult. Respondents’ most popular priority for incoming NHS England chief executive Simon Stevens was for him to work to “change competition and choice rules, to reduce their effect on the NHS”, with 81 per cent agreeing.

One London chief officer said: “The competition rules are a constraint on developing new models of care, particularly to support the integrated care agenda.

“We are constrained from making sensible decisions about working with local providers to develop innovative out of hospital responses when providers know that they might not be successful in securing contracts on a longer term basis.”

Full results

CCG barometer Dec 2013 graphs

CCG barometer Dec 2013

NHS funds will subsidise councils' services, CCG leaders believe