Page 0025

Figure 2: In your view, what are the main underlying causes of

delayed transfers of care?








relevant partners

Lack of adequate

incentives in the

system (e.g.



e.g. speed of


Shortfall of




The care provided to those in hospital has been designed around treating

individual isolated problems. However, older people are most in need of coordinated care and are most likely to experience transitions between types of

care. Payment systems do not lend themselves to treating patients with multiple

conditions, as patients with multiple needs may require longer appointment


As one interviewee said: "We need to move towards a system that rewards

outcomes rather than activities. The existing system pays if patients don't get

better, get worse, or even die." Or, as another put it, "independent funding

streams provide no reason for Health and Social Care to change the way

they operate and should be replaced with pooled budgets that foster greater

integration." A significant number of interviewees mentioned significant failures

in the incentive structure. Clearly if what we were told is correct and these

reports are accurate then the system is mitigating against the right results for

older people.

An attempt to introduce a more rational incentive is the Better Care Fund (BCF),

announced in 2013. The BCF is designed in to be used for joint NHS-local

authority commissioning of integrated health and social care services.

However, of the total £3.46 billion allocation in 2015/16, £1 billion is made

up of 'payment for performance' incentives. The incentives are only received

if Health and Wellbeing Boards can hit a set target for a reduction in total

emergency admissions of at least 3.5 per cent for the year.75 Where this target

isn't achieved, this proportion of the funding (almost a third) will be handed

back to the NHS leaving local authorities even more financially stretched.

Indeed when giving evidence to the Public Accounts Committee in December

2014, the chief executive of the Local Government Association (LGA) Carolyn

Downs said that the LGA had considered walking away from the Better Care

Fund programme due to the burden of risk placed on councils.76 The concept

behind the creation of the Better Care Fund - to catalyse the integration between

health and social care that we argue is so desperately needed - is very welcome.

However, it is to be hoped that future iterations of the programme can achieve

a more equitable balance of risk and reward for both sectors.

Promisingly, Samantha Jones, the recently-appointed Director of Care Models

NHS England's, stated in her first interview that proposals to develop pioneering

health and social care models will need to demonstrate meaningful clinical 74 The King's Fund, Making our

health and care systems fit for an

ageing population (2014)

75 Department of Health,

Department for Communities

and Local Government, Better

care fund policy framework

(December 2014)

76 Peters, D, "Councils 'were close'

to dumping the BCF" The MJ (2

December 2014)

Chapter 3 - What Is The Diagnosis? Or Why Are We Failing Our Elderly?



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