Audit Commission: Pooled care funding makes little impact

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”.


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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