The Integrator: Capping acute funding uplifts for the wider good

One of Labour’s NHS election pledges was a commitment to ensure a larger share of the NHS budget goes to community and primary services by the end of its first term in power.

NHS leaders have long argued they want to do the same with the argument being that, done well, it will take the strain off the acute sector and save money in the long run and contribute to better, more integrated care.

But while everyone appears to agree on the principle, the “how you do it” – i.e. deliver one of the most profound funding shifts in recent NHS history – is much less clear.

NHS England is certainly giving increasing airtime to answering the question. Chief executive officer Amanda Pritchard gave the topic top billing during her speech at the NHS Confederation conference in June, as The Integrator noted at the time. 

Ms Pritchard cited two main “triggers” to drive this change: first, the need to get away from the block contracting which has remained in place for many acute services since covid (and has always been the method of funding for most other parts of the NHS), and that some fear is harming productivity.

The second trigger was the need to weave financial incentives for shifting more care into the community into the way money routinely flows through the service, something she acknowledged past efforts had largely failed to do.

Cambridgeshire grasps the nettle

While much of this remains at the theoretical stage, one integrated care board which is already trying to work out how such a shift could work in practice is Cambridgeshire and Peterborough Integrated Care Board.

The plans are still in their early stages but will be closely monitored by other ICB chiefs, not least because The Integrator has learned other systems across the East of England region have discussed using C&P as a blueprint to follow if it is successful. 

C&P has already been holding funding for its acute trusts flat, although allowing annual increases in line with inflation, for the last couple of years under a regime to hold down costs.

This was a measure introduced to help the ICB exit from what was then called system oversight framework “segment 4” – NHSE’s group of the most challenged ICBs.

Initially, any extra money went to plug gaps in their financial plan. But the next phase is to ensure that additional money received for growth is funnelled into primary and community care.

It has committed to this approach over the next five years. Its joint forward plan up to 2029 says: “The basis of our financial strategy is a flat cash approach and where possible utilise new funding to support the community and prevention regime.”

The Integrator asked C&P how much uplift has been funnelled into community and prevention so far but it said it was unable to give figures yet.

So, at this stage, it’s impossible to judge the model and it remains a case of watching and waiting to see how the plans pan out.

The rest to follow?

With other East of England ICB leaders confirming they have been consulted on how such a model could operate within their systems much is riding on this project, not just for C&P, but for the whole region.

However, while one senior figure we spoke to believed the project was a good idea, they warned such a shift would create obvious risk for the acute providers, which are already under intense pressure without the prospect of less generous funding deals. 

They told The Integrator a robust business case to demonstrate how the move would deliver system-level benefits would be needed before such a plan would be signed up to more widely, especially by acute bosses. 

C&P is clear however that such transformational change is the only way it will address what it calls its “unsustainable” financial position over the coming years.

We also understand C&P CEO Jan Thomas has carried out a wider piece of work looking at financial sustainability across the whole East of England region – which also says similar transformation funding shifts are required across the rest of the region to deliver a financially sustainable future.

This only further underlines why this project is worth keeping tabs on – not only for the East of England but also for how Labour is going to deliver one of its key NHS manifesto pledges.

Both C&P ICB and NHSE East of England were approached for comment.