There is limited evidence that pooled funding across health and
social care in England has led to service improvements, with
partners lacking indicators to measure success, the
Audit Commission warned today.
In a report, the regulator said councils, primary care trusts
and NHS trusts needed to make outcomes for patients and users the
focus of joint funding arrangements, instead of concentrating on
the processes of pooling finance.
Government must enable joint working
However, it also said government needed to do more to enable
councils and trusts to work together, including by
establishing joint performance indicators for PCTs and
councils.
Under legislation consolidated in the
National Health Service Act 2006, trusts and
councils can pool funds, delegate functions to each other, set
up integrated teams and establish care trusts - fully integrated
organisations which commission or provide health and adult
social care.
The biggest area for pooled funding is learning disability
services (£2.4bn in 2008-9), with pooled mental health funds worth
£1.1bn in 2008-9 and integrated community equipment services being
the other big area of joint funding.
No difference in performance
While joint financing is designed to improve efficiency and
performance, the report found little difference in lengths of stays
in mental health hospitals, emergency bed days in hospital for
older people and speed of delivery of equipment between areas with
and without joint funding arrangements.
It said while organisations could point to improvements in
mutual understanding and processes, few could identify improvements
in outcomes for users.
Partnership arrangements rarely set out specific or measurable
indicators of performance, while outcome measures that were in
place were not systematically monitored.
However, it said central government should also do more to
support joint working.
Lack of national indicators
The report identified a lack of national indicators related to
integrated services and commissioning, and also highlighted
the need for trusts and councils to make separate financial returns
to government as a problem.
Councils also felt that the world class commissioning
programme, against which PCTs are assessed, did not fully recognise
the need for trusts to engage with councils, the report said.
The first round of assessments for the programme only had two
indicators related to integrated working by trusts, on pooled
funding for and council spending on adult mental health services,
which the report said was a "narrow focus" involving data that were
"not wholly reliable".
Recommendations
The report's recommendations included for NHS bodies and
councils to set and monitor measurable outcomes for service users
for all their partnership arrangements, and to draw up written
joint funding arrangements, which should be regularly reviewed.
It also urged the Department of Health to identify a set of
outcome measures which directly relate to joint working, which
should be consistently applied and carry equal weight in the NHS
and local government.
Responding to the report, David Stout, director of the NHS
Confederation's Primary Care Trust Network, said: "While the
rationale for joint working should always be with the view to
creating improved patient services, it requires dedicating
significant attention to planning in order to have minimum
disruption to patients, staff and the public."
The report was based on national performance and finance
figures, a survey of trusts and councils and further evidence
from 15 councils, 13 PCTs, four mental health trusts and three care
trusts.
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