The Department of Health’s decision not to withhold better care fund cash from areas struggling to improve performance looks at first glance like a softening of central control.
Whether it is depends on the “support” offered in place of financial penalties - is it light touch or heavy handed? Either way, the underlying idea is that there is a wealth of experience scattered across the country to bring to bear on performance issues such as avoidable emergency admissions or delayed transfers of care. The thinking is: whatever the problem, someone somewhere in the health and care system will have solved it.
The performance related element of the better care fund is therefore transforming into a lever for forcibly disseminating best practice.
But that is challenging for clinical commissioning groups. After all, the whole point of them is that they are local, with liberated local clinicians using their local expertise to unravel all those knotty local problems.
What if it turns out that service leaders in Barnsley have the answer to Birmingham’s delayed transfers problem, or North East Lincolnshire can show Rochdale how to use reablement services to keep patients from boomeranging back into hospital? It would be a blow for the localist premise of CCGs as it suggests that some of the defining problems in the NHS are at least partly universal in character, rather than unique in each community.
The DH is now looking to force areas to adopt best practice from elsewhere. It is a modest but important shift away from the “let a thousand flowers bloom” localism of the 2012 Health Act.