The Local Government Association and NHS England wrote to CCG Clinical Leads, Health and Wellbeing Board Chairs, Chief Executives of upper tier Local Authorities and Directors of Adult Social Services on 17 October 2013 to explain the steps required to be taken now to prepare for the implementation of the Integration Transformation Fund (ITF) that was announced in the spending review at the end of June 2013.
The ITF will be £3.8 billion worth of funding to be allocated in 2015/16 to be spent locally on health and care to drive closer integration and improve outcomes for patients and service users. In 2014/15 an additional £200m transfer from the NHS to social care (in addition to the £900m transfer already planned) will enable localities to prepare for the full ITF in 2015/16.
The letter urges local authorities and CCGs to start now to create a shared plan for the totality of health and social care activity and expenditure in 2015/16. Long term planning seems to be the key and the letter headlines that the NHS planning framework for 2014/15 will invite CCGs to agree five year strategies including a two year operational plan that covers the ITF with their local authorities through their Health and Wellbeing Boards.
It is worth reminding ourselves that the ITF is not new money - the £3.8bn pool merely brings together NHS and local authority resources that are already committed to existing core activity. Therefore those funds will need to be redirected to shared programmes designed to deliver better outcomes for individuals. CCGs and local authorities working together through their Health and Wellbeing Boards will need to develop a shared approach to delivering services and setting priorities to take advantage of what is being described as "an unprecedented opportunity to shape sustainable health and care for the foreseeable future".
In addition CCGs and Local Authorities will need to engage with local NHS and social care providers likely to be affected by the use of the fund to develop a shared view of the future shape of services including an assessment of future capacity requirements across the system and an acceptance that the implications for local providers may require service changes that include disinvestment from current services.
We all need to look out for the promised monthly bulletins updating us on the ITF.
An annex to the 17 October letter sets out detailed further information on:
- How the pooled fund will be distributed;
- How councils and CCGs will set goals and be rewarded for achieving them;
- Possible changes in the statutory framework to underpin the fund;
- The format of the plans for integrated care and a template to assist localities with drawing up plans that meet the criteria agreed for the fund;
- Definitions of the national conditions that have to be met in order to draw on the polled fund in any locality; and
- Further information on how local authorities CCGs NHS England and government departments will be assured on the effective delivery of integrated care using the pooled fund.
Of particular interest to commercial health lawyers are the "Possible changes in the statutory framework to underpin the fund".
It is already clear that in 2015/16 the ITF allocated to local areas will be put into pooled budgets under joint governance between CCGs and local authorities.
The Department of Health is now considering whether legislative changes will be necessary to establish the ITF to create ITF pooled budgets and to implement the promised 'payment for performance' framework. Apparently the Government is exploring options for including any required legislation in the Care Bill and further details will be made available in due course. Until then the wide powers to use Health Act flexibilities ie section 75 partnership arrangements to pool funds share information and staff are unaffected and will be helpful to CCGs and local authorities in preparing for ITF in 2015/16.