NHS England has announced factors including delayed transfers of care and levels of emergency admissions will impact on how much money each area receives from the new £3.8bn integration fund.
Planning guidance published today by NHS England confirms that £1bn of the total will be paid depending on local performance and how well arrangements are put in place with the intention of safeguarding integrated services.
The performance related element will apply from 2015-16, when the “better care fund” – formerly known as the integration transformation fund – takes full effect.
In April, £250m will be paid if the following conditions are met:
- protection for adult social care services;
- provision of seven day services to support patients being discharged and to prevent unnecessary admissions at weekends;
- “agreement on the consequential impact of changes in the acute sector”;
- and the putting in place of an “accountable lead professional” for integrated packages of care.
A further £750m is explicitly performance related, and will be paid if local areas succeed against five national metrics and one other measure to be identified locally by clinical commissioning groups and councils.
The national measures are:
- delayed transfers of care; avoidable emergency admissions;
- admissions to residential and nursing care;
- “effectiveness of reablement”; and
- a patient experience measure, yet to be identified.
NHS England’s planning guidance says this £750m will be released in two stages during 2015.
One third of it be paid out in April 2015 depending on local progress against the locally agreed metric, and the following three national measures: delayed transfers of care; cutting avoidable emergency admissions; and the patient and service user experience measure.
In October 2015, a further £500m will be released, based on further progress against all five national metrics, plus the locally agreed one.
Clinical commissioning groups and local councils will be able to choose which “local metric” they want to be assessed on, although NHS has suggested a menu of nine outcomes measures.
NHS England’s planning guidance also sets out how the better care fund will be allocated.
In 2014-15 the fund will be worth £1.1bn, and will be allocated according to the social care relative needs formula – the formula which is currently used to distribute NHS funding that supports joint working between health and social care.
This arrangement will continue in 2015-16. The social care formula will also be used to distribute an extra £134m of social care capital funding.
From 2015-16, £220m of additional funding will be distributed to lower tier councils, from the disabled facilities grant. This will be passed on to housing authorities, which have a statutory duty to provide adaptations for disabled peoples’ homes.
The rest of the better care fund – worth around £2.4bn - will be distributed according to the CCG funding formula. It means the £3.8bn fund will be allocated through a mix of social care and NHS formulas.
NHS England has also said further legislation is needed to ensure the better care fund can legally be set up from 2015-16.
“Legislation is needed to ring-fence NHS contributions to the fund at national and local levels, to give NHS England powers to assure local plans and performance, and to ensure that local authorities not party to the pooled budget can be paid from it,” the planning guidance says.
A Department of Health spokeswoman said: “As we confirmed in yesterday’s second reading debate on the Care Bill, we intend to amend the bill in the new year to add provisions that will facilitate the new better care fund.”