Health and local government ministers have insisted better care fund cash will not be diverted by councils into non-health projects.
In HSJ and Local Government Chronicle’s interview with Norman Lamb and Brandon Lewis, the two ministers sought to play down fears expressed by NHS England’s medical director at a Commons health committee hearing last month. Sir Bruce Keogh said: “There is a fear that the labels [will] be taken off the money and that it will be used for filling in potholes and other significant things.”
However, health minister Mr Lamb said it was “just wrong” to suggest the programme would allow councils to use NHS funds to fill potholes, adding “we will not let that happen.”
When Mr Lewis, a minister at the Department for Communities and Local Government, was asked whether he had confronted Sir Bruce about the claim, he said: “I haven’t seen him but I don’t agree with him.”
Mr Lewis said of Sir Bruce’s concern: “I’m confident that won’t happen – local government will do the right thing as it generally does.”
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But the local government minister said the actions of some councils could cause a loss of confidence in the sector. He referred to a Commons question in which Enfield Council was accused of using public health money for road maintenance.
“They had this tenuous argument that it would stop people having accidents,” Mr Lewis said. “That does nobody in local government any favours and it’s an atrocious way to behave.
“But that isn’t local government. Local councils across the country know what this is about and they’ve got a vested interest in getting it right. The Enfield example is a salutary lesson to every council that that won’t be tolerated, they won’t get away with it.”
Sir Bruce’s concerns reflected serious misgivings in the acute sector about the prospect of a major transfer from their budgets to social care. NHS England guidance said use of the fund should lead to a 15 per cent fall in demand for emergency activity - an outcome that could be hugely destabilising for the NHS if not carefully managed.
“One of the ways we’ll know this [fund] is working is if that demand falls,” Mr Lewis said. “In a sense if we need less A&E because we’ve dealt with the problem, that’s a good thing.”
For his part, Mr Lamb said nervousness in the acute sector was “exactly what one would expect at this stage”.
“Hospitals have become reliant on payment by results as a method of funding, and starting the shift away from that inevitably causes concerns,” he said.
“But you have to look at the counterfactual all the time. You can point to the pressures and the risks of proceeding down the right route, but we have to look at what happens if you carry on with business as usual. For me that results in the NHS crashing and that’s a scenario we’ve got to avoid.”
Mr Lamb admitted that the example of Oxfordshire, where NHS providers effectively put the brakes on an ambitious integrated contract plan, showed the system was “enormously risk averse”. He said the 14 local integration “pioneer” areas, designated by his department, were starting to change this approach. He said these areas had become “all the more important” since the introduction of the better care fund because other areas would look to them for lessons.
To this end, he said, the 14 pioneer sites would be able to go directly to some of the most senior figures in the NHS and local government for support. These included Department of Health director general for social care Jon Rouse, NHS England national policy director Bill McCarthy and Local Government Association chief executive Carolyn Downs.
“If we can get to understand better what the barriers are to sorting out a problem like delayed transfers of care and then rapidly disseminate that… you avoid too high a risk of making mistakes,” he said.
Both ministers suggested the fund, if successful, could have significant implications for future reform.
Mr Lamb said his personal view was the fund was a step towards “the pooling of the whole health and care resource in a local area”, which would help to ensure the rational use of resources.