It’s official, from a value for money (VfM) perspective, the Better Care Fund has not delivered what was expected, in terms of savings, outcomes for patients or reduced hospital activity, from the £5.3 billion spent through the Fund in 2015 – 2016.
The National Audit Office defines VfM as the optimal use of resources to achieve the intended outcomes and uses three criteria to assess it – spending less, spending well and spending wisely (and where appropriate spending fairly). This would be all very reasonable but for the small matter of context and perception. After all, VfM should always be from the perception of the receiver of care. In social care, proof of good VfM is ultimately the recipient of care believing or concluding that the care they received was worth the price paid, regardless of who paid for it.
Applied within families, VfM can cause minor arguments, amongst local communities the potential for significant difficulties is real and between large organisations identifying, agreeing and achieving VfM becomes a highly complex interminable process with the reality of spending less a pipedream.
So, should we be surprised that the NAO’s Integrated Health and Social Care Report states that the Better Care Fund hasn’t achieved the expected VfM? No, the writing has been on the wall for years. In further analysis, should we be surprised that we’re not spending less? It depends on what, and where, in the health and social care ecosystem we’re looking. Should we be surprised at the lack of efficiency associated with the 20 years of the integration agenda? Probably. Should we be surprised at the lack of effectiveness? Definitely.
Yes it’s complicated, yes it’s huge, yes it requires revolutionary change and yes you’re right there isn’t a simple answer. However, let us just consider for example a microcosm of the whole health and social care system – home and residential care. Here, as part of economy, efficiency and effectiveness, councils have successfully pushed down charges. However, does the same for less offer value at an organisation, provider or individual level and can it be sustained? Evidence suggests not.
Falling home and residential care rates have reduced market capacity, choice and equality of access, and has also led to unprecedented levels of ‘bed blocking’. People have moved inappropriately or too quickly along care pathways and much of the delivery associated with these services has been dehumanised. For providers, it has created recruitment and retention difficulties, led to costly training and development issues, along with falls in service quality, ultimately rendering many businesses unviable. From a workforce perspective, many can no longer afford to remain in the sector.
So in this instance can we achieve real and sustainable VfM? Yes, I firmly believe we can if councils are willing to:
1. Put the person at the centre – in control of all aspects of their care and support with councils, health and providers acting as enablers supported through person-centred solutions. As empowered individuals, they are then able to make informed decisions about their lives and have the freedom to choose who and how they draw on support, experience and advice of others.
2. Simplify – the actual care journey and many of the complexities of providing choice and self-management to people
3. Transform - the way of working for those organisations that have responsibility for providing, facilitating and funding care-related advice, services and products
4. Shape the market and avoid costs – stimulate an open and competitive market that will start to drive quality and unit pricing through informed consumer buying behaviours. Excessive costs can be avoided by actively promoting preventative, community-based, lower cost offerings and, therefore, helping people remain active, valued members of the community should be the most cost effective way to meet needs and also help to reduce costs on traditional services
5. Provide transparency of care related activity and spend in ‘near real time’ – to the person, the provider and the council. This would enable the individual to manage their care and monies more easily. Providers and caseworkers would know when services differ from the expected and therefore be proactive in resolving issues. It would help commissioners with market shaping and enable directors to know how budgets are being managed irrespective of how individuals want their council funded care to be handled.
Councils need to spend well and wisely but to bring VfM to reality requires a radical new way of thinking. I believe the five areas highlighted in this blog bring a future of greater VfM into view.