Means to an end

This report reviews the joint financing and integrated care arrangements between NHS bodies and councils with adult social care responsibilities. It builds on our previous publication, Clarifying joint financing arrangements, that explained the practical implications and legislative framework for joint financing.

It considers how these arrangements are used, focusing on learning disability, mental health and older people - areas where service users most often need health and social care.

The report's recommendations and examples of notable practice aim to help national and local bodies better understand the options available, how to use them and to achieve better outcomes for service users.

Published October 2009, 68 pages

Direct payment for health care: a consultation

This consultation document seeks views on the Government’s proposals for piloting direct payments for health care. This is part of the wider pilot programme to explore personal health budgets announced in High Quality Care For All. PCTs are already able to offer personal budgets that do not involve giving money directly to individuals. The Health Bill, which has now completed its main Parliamentary stages, would extend these options by providing power to allow direct payments, where the individual would be given the money to buy their own health care as agreed in a care-plan.

Published October 2009, 41 pages

Independent sector treatment centres

Independent sector treatment centres (ISTCs) provide services to NHS patients but are owned and run by organisations outside the NHS. This briefing paper explains why ISTCs were introduced, and how they are funded, staffed and regulated.

It assesses their impact so far, including the quality of their services and whether they provide good value for money. Finally, it examines what their future may be now that the contracts ISTC providers hold with the Department of Health are beginning to expire.

Published October 2009, 10 pages

Auditors’ Local Evaluation and Use of Resources 2008/09

Each year, the Audit Commission assesses how well NHS trusts and primary care trusts manage their resources and deliver value for money. For 2008/09, these assessments have been based on the Auditors' Local Evaluation (ALE) for NHS trusts and Use of Resources (UoR) for primary care trusts. We have published a national report outlining the scores and how they should be viewed in the context of the overall financial performance of the NHS in 2008/09, which is one of a continued improvement in financial stability. NHS foundation trusts are assessed by Monitor.

Published October 2009, 84 pages

Transfer of Learning Disability Social Care Funding and Commissioning from the NHS to local Government

Since 1 April 2009, funding and commissioning responsibility of social care for adults with learning disabilities transferred from the NHS to local authorities. Further guidance on capital transfers and other financial and practical issues is provided.

Published 2009

The link between health spending and health outcomes for the new English primary care trusts

This report describes a model which takes into account population need in a way that has not previously been undertaken. The authors note that their work has a number of limitations including the use of a rather narrow outcome indicator (mortality) and the need to assume a relatively stable pattern of spending by PCTs across programmes over the recent past. Notwithstanding these limitations, the study offers clear confirmation that current expenditure by PCTs on some important programmes of care is highly cost-effective and illustrates how programme budgeting data can be used to generate information which might usefully inform PCTs' spending decisions.

Published June 2009, 64 pages

Prospects for NHS funding: 2011-2017

NHS spending in England may have more than doubled in real terms since 1999/2000, but the prospects for future funding now look bleak. Although there is consensus that the NHS faces a tough financial future, there is no agreement about just how cold the financial climate will be. Starting with a look at historical funding for the NHS, The King’s Fund and the Institute for Fiscal Studies set out three plausible future funding scenarios and their consequences. The paper concludes with an assessment of each scenario and the options for funding up to 2017.

Published July 2009, 28 pages

Organisational Health

Organisational and system health; a new perspective on performance improvement? A new report from NHS Institute and Matrix Insight gives an accessible introduction to concepts of organisational health, details of case studies and a summary of implications for the NHS.

Published 2009, 33 pages

Commissioning in a cold climate

The World Class Commissioning programme is designed to improve the capacity and capability of primary care trusts (PCTs) to deliver better care, better health and better value for the populations they serve.

This discussion paper outlines the challenges facing commissioners over the next few years and identifies actions that PCTs might take to prepare their health economies for what is to come.

Published June 2009, 12 pages

Social Care: reform of funding and delivery

There is almost universal consensus that the current system of social care funding is unsustainable and in urgent need of reform. Many older people and adults with disabilities, well as their families and carers, are being failed now and under the existing arrangements highly unlikely that in future the state will be able to support the costs of rising demand for long-term care. By 2026 it is estimated that one in five people will be aged 65 or over and number of over-85s will have increased by two-thirds – this compares with overall population growth of just 10 per cent. The 2009 Budget revised down the government’s forecasts for what it expects to spend on public services and benefits from 2011/12, but given that the existing system is unsustainable doing nothing is not an option, even in the current economic climate. This briefing from The King’s Fund looks ahead to the Green Paper on social care, expected in June, and sets out the key tests that any new settlement will need to meet.

(Published May 2009, 3 pages)

Practice-based commissioning budget guidance for 2009/10

PCTs are responsible for ensuring that practices receive an indicative budget that reflects the needs of their population as accurately as possible. This allows a practice to access a 'fair share' of the resources available to the whole of the PCT for its patients. The Department has updated the toolkit that can be used to determine weighted capitation indicative budgets at practice level. This is part of the DH ongoing commitment to refine the methodology and improve accuracy.
To accompany the toolkit the DH have also produced guidance which sets out:

• Changes to the recommended methodology for deriving practices fair shares for 2009/10
• Changes to the minimum pace of change to practices budgets for 2009/10
• Information on how to use a new toolkit that can help PCT set budgets

Published February 2009

The NHS in England: The operating framework for 2009/10

The operating framework sets out a brief overview of the priorities for the NHS next year. It is accompanied by annexes (some part of the document, some web-based only) which provide more detail on the priorities, how they are measured and how the new arrangements for managing the system will work.

Published December 2008, 52 pages

The standard NHS contracts for acute hospital, mental health, community and ambulance services and supporting guidance: These documents represent Annex D to the NHS Operating Framework for 2009-10

Clarifying joint financing arrangements : A briefing paper for health bodies and local authorities

A briefing that demystifies pooled funds and Section 75 of the NHS Act 2006 and reviews the current range of joint financing arrangements between NHS bodies and local authorities across health and social care. It is the first in a series of publications relating to a national study which is due to be published in spring 2009.

Published December 2008, 42 pages

Three new NICE Commissioning Guides

The National Institute for Health and Clinical Excellence (NICE) has published three new commissioning guides to help the NHS in England effectively commission evidence-based care for patients. The guides cover services for:

• Accurate diagnosis of the epilepsies in adults
• Antenatal and postnatal mental health
• Peer support for women who breastfeed

Guides also due for publication before the end of the year will cover services for:

• Obits media with effusion
• Patient education for people with type 2 diabetes
• Smoking cessation for people having elective surgery
• Diagnosis and initial management of stroke
• Diagnosis and initial management of transient ischaemic attack
  

Each commissioning guide signposts and provides topic-specific information on key clinical and service-related issues to consider during the commissioning process. They also offer an indicative benchmark of activity to help commissioners determine the level of service needed locally. Within each commissioning guide, an interactive commissioning tool provides data for local comparison against the benchmark and resources to estimate and inform the cost of commissioning intentions. NICE has updated population, activity and tariff data presented within the 15 commissioning tools already published. The ‘one stop’ resource now brings together more recently available data and will help users review current commissioning activity and make robust commissioning decisions to improve the range and quality of health services available to patients.

Tutorial for using commissioning tool.

Transfer commissioning of social care for adults with a learning disability from the NHS to local government

This letter and annex set out the existing policy and legal framework for the transfer of learning disability social care funding and commissioning from the NHS to local authorities with effect from 1 April 2009. The annex provides guidance on what is covered, what PCTs and LAs need to do and the timescale for the transfer. The proposed transfer was set out in Valuing People Now.

(Published August 2008, 15 pages)

Financial risk in health purchasing: risk pools

The point of minimum financial risk is reached by placing between 20 per cent and 40 per cent of the inpatient budget into the risk pool. Allocating only five per cent of the budget to a risk pool requires a population base equivalent to the whole of England to achieve a one per cent tolerance on the risk pool. Moving 35 per cent of the practice based commissioning [PBC] inpatient budget into a primary care trust [PCT] held budget leads to between three per cent and eight per cent risk associated with the PCT retained budget for the largest and smallest PCTs in England respectively, i.e. only risk pools consisting of groups of PCTs are sufficiently large to mitigate financial risk.

British Journal of Health Care Management 2008; 14 (6): 240-245

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Financial risk in practice based commissioning

The financial risk associated with healthcare budgets is high. To operate within a financial tolerance of less than three per cent a PBC [practice based commissioning] group will need a population of greater than 50,000 (budget £15 million). The point of minimum financial risk is reached by placing all admissions costing more than £3,000 into a larger risk pool. A core of 47 HRGs [health resource groups] accounting for 30 per cent of the budget, are the only HRGs with sufficient volume for a PBC group to discern whether a statistically significant reduction in costs has been made.

British Journal of Health Care Management 2008; 14 (5): 199-204

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DH Social Enterprise Fund open for business

Care Services Minister Ivan Lewis has announced the opening of the second round of the Department of Health (DH) Social Enterprise Investment Fund. He also announced that this year, it would include a new element, the 'Innovation for Life Challenge Fund', developed in collaboration with the Social Enterprise Coalition. The Innovation for Life Challenge Fund will encourage Strategic Health Authorities (SHAs) and their partners to find collaborative solutions to health and social care needs through social enterprise.

Under One Roof: Will polyclincs deliver integrated care?

Government policy is driving a fundamental shift of care from hospitals to more community-based settings. There is a growing expectation that this shift will be supported by the development of a network of new facilities in which primary, community and secondary care services are co-located, often referred to as polyclinics. Will this model improve the quality and accessibility of health care and deliver cost savings? Drawing on published information and original research into facilities similar to the polyclinic model in the United Kingdom and abroad, this report identifies and explores both opportunities and risks in relation to: quality of care, accessibility of services and cost.

Published June 2008, 67 pages

Revised guidance: primary care dental contracts Advice on managing end of year issues

Guidance provided in January 2007 (Gateway reference 7719) has been updated to reflect comments from the NHS and to clarify expectations for the end of the financial year. The guidance is now generic and does not relate to any one year in particular.

(Published April 2008, 13 pages)