Financial and managerial incentives should be used to shift care to the community, MPs were told in the Health and Social Care select committee (HSCC) yesterday.
The HSCC session discussed how the government can deliver their ambition to shift care from hospitals into community settings, ahead of the 10-year plan.
When asked about what one thing NHS England could do to incentivise ICBs to deliver and prioritise services in the community, Stephanie Elsy, chair of Bath and North East Somerset ICB said that there needs to be a ‘strong steer’ that it is important.
‘Include it in the planning guidance and measure what we’re doing on it,’ she said.
On ringfencing funding, she suggested the planning guidance could include that a certain percentage of funding should be used for mental health and community services.
‘If we think things are really important, there needs to be a strong steer from national government and from NHS England,’ she said. ‘It’s critical for the success of systems and therefore you need to make sure that those funding streams are catered for.’
Melanie Williams, president of the Association of Directors of Adult Social Services, agreed that this task should be part of planning guidance and added there needed to be ‘bold political action’ to make the shift from hospital to community care.
‘We do need a radical shift in our financial and managerial incentives,’ she said. ‘We set up integrated care systems (ICSs), then immediately there was pressure on ICBs to reduce leadership at place. And that’s what happened. So many ICBs reduced the inequalities fund, the leadership at place, moving us away from that shift from hospital to community.’
She said if there is not a ringfenced protection of the funds, ‘the shift won’t happen’.
‘We need to be really imaginative in how we use the policy leavers to rebalance the investment from non-acute services,’ she added.
‘The bit we really struggle with is moving funding that’s allocated nationally to healthcare into other things that aren’t the NHS, whether that’s public health, social care, community support, accommodation. It’s seen as an NHS budget rather than a health budget,’ she said.
‘Starting to see that as a different, radical shift in the way we think about that resource would enable us to feel more comfortable about the money moving into other forms of support that aren’t necessarily NHS led, because in proactive, personalized care, there’s a whole range of things we need to build around communities to make that a reality.’
Saffron Cordery, interim chief executive at NHS Providers, added that it was ‘really important’ to think about what is trying to be achieved when setting funding allocations.
‘If we see the end of something like the mental health investment standard right now, what we will see is the marginalization of people with severe and enduring mental illness,’ she said.
‘We will see more crises turning up at our A&E departments. We will see more challenging situations which impact not just acute care, they impact the individuals themselves who are suffering, but also impact across other bits of the public service, like the police, education, etc.
‘So we need to make sure that we’re building on some really good progress that we’ve made, to continue that and build that into the funding framework, funding services in the community, funding mental health, funding social care, funding primary care. They are steps in and of themselves to shift the demand, but they are also important to provide the right kind of care that people need.’
In the second half of the session, MPs also heard calls for more funding into core general practice and that GPs should be trusted to use funding as they see fit, rather than setting up ‘small, disconnected post of money’.
Royal College of Nursing (RCN) chief executive and general secretary Professor Nicola Ranger also stressed the importance of investing in the general practice nursing workforce, such as senior nurses who can help free up GP time.
It comes as a report last week suggested that personalised care was ‘inconsistently’ delivered across the NHS.
Last month, MPs were told that planning guidance would ‘hopefully’ be out before Christmas.
