Exclusive: Health secretary Jeremy Hunt has told HSJ the government’s decision to create a £3.8bn joint commissioning pot for the health and social care needs of vulnerable people is a “big game changer”.
Chancellor George Osborne revealed in today’s spending review that the amount of NHS funding transferred to social care would more than treble in 2015-16, up from around £1bn the preceding year.
In an exclusive interview with HSJ, Mr Hunt declared the decision was “a huge moment in the NHS’s history.”
He said it would give birth to the NHS’s first “accountable care organisations”. It would also introduce the idea of an accountable clinician for every vulnerable person receiving care in the community. This was necessary as “the NHS needs to restore clinical accountability outside hospitals”.
He added that social care would be required to move to a “seven day” working arrangement if it wanted to access the funds.
Although the joint commissioning pot will be available for services aimed at all vulnerable people, those targeted at the elderly are likely to be the main beneficiaries.
Mr Hunt rejected Labour shadow health secretary Andy Burnham’s proposals for a government mandated full merger of the NHS and social care budgets. He said the coalition’s plan would drive extensive integration across health and social care without “the upheaval and organisational disruption” of a “massive re-organisation of budgets and structures”.
He added: “If, in order to access critical extra money you have to have joint commissioning, the joint commissioning won’t be just for that sliver of extra money – people are going to look at the whole system holistically”.
“We will achieve what older people need – seamless, integrated services – but without the upheaval and organisational disruption you get from having a massive re-organisation of budgets and structures,” he told HSJ. “If we had a huge upheaval – it would paralyse the system for a couple of years.”
The health secretary claimed: “As far as this government is concerned we believe in integrated care and this is something that has been talked about for decades. The last government didn’t deliver it – the silos got worse and we are finally doing something about it.”
Around £1bn is already transferred each year from the NHS budget to help social care cope with the reductions in local government spending.
Should the coalition win the next election those funds would be more than trebled in 2015-16 and allocated “according to need” to each of England’s 150 local authorities. According to an NHS England document seen by HSJ, £3.4bn of the £3.8bn pooled fund would come from the NHS. The outstanding £0.4bn would be capital grants from the Department of Health and other government departments.
Mr Hunt told HSJ: “What happens at the moment is that we hand over a £1bn to social care and we say this has to help health needs – but those needs are very broadly defined. This time it’s completely different. In order to access the £3bn pot local councils and CCGs will have to do joint commissioning for vulnerable older people.”
He added: “They will have to fully share data. They will have to have a service where there is a single organisation responsible for the services an older person receives. It may not be the same organisation doing every part – but [there will be] one accountable care organisation.”
Accountable care organisations are given responsibility for health of a particular population and are rewarded for improving outcomes. Mr Hunt said the NHS’s accountable care organisations could resemble the US’s healthcare firm Kaiser Permanente, except “this is only for vulnerable older people, it’s not for everyone”.
The health secretary explained that to access the funds clinical commissioning groups and health and wellbeing boards must bring forward “extremely ambitious” plans “that meet the aspirations we have for properly joined up integrated care”. The plans will have to be signed off by health minister Norman Lamb and a member of the Communities and Local Government team.
The plans can be signed off this year, enabling CCGs and local authorities to begin to develop their proposals.
Mr Hunt said: “The integration pilots announced by Norman Lamb are going to be very significant. We have got some parts of the country that are incredibly enthusiastic about going much further even than the kind of things we’re talking about and we want to allow them to do that and we want to see how those work. We want to create space for innovation.”
The appointment of an “accountable clinician” meant that “when a vulnerable person is discharged from hospital, responsibility for them is handed over from one [accountable] clinician to another”, said Mr Hunt.
Vulnerable patients would know which clinician was responsible for their case management and how to contact them. The health secretary said: “A big part of the change I would suspect would be better clinical care of people in residential care homes. That is a gap in the current system. In some places it happens well, in other places it doesn’t.”
The “accountable clinician” was likely to be a GP “in the vast majority of cases.” But added he was not going to mandate the model, as “there may be areas where acute trusts want to provide this service.”
According to DCLG figures, spending on adult social care was projected to be £14.7bn in 2012-13.