Every acute trust is facing three challenges: the elective care debt, urgent care recovery and an exhausted/depleted workforce. With Integrated Care Systems (ICSs) on the horizon, we have an opportunity to step back and look at the bigger picture to see where we can make system improvements to meet these challenges and add value to the patient, public and taxpayer. However, it is difficult to understand what is going on in any given health and care system because the finance framework and metrics we have are currently not defined and aligned enough to help us determine exactly the value (cost and outcome) of activity we are getting for the funding.
Funding review for ICSs must be based on a clear picture of each health system
Each ICS NHS body will be responsible for allocation of funding at system level. The aim is to distribute resources according to population need and to help reduce health inequalities.
However, all payment systems are complex and to ensure the right calculations for payment of care and enable health systems to provide the right care in the right places, it is vital to have access to the right sources of data. Where patient-level data is limited, this can impact on how system budgets are allocated.
Currently we are operating with a mixed economy of block and activity contracts. Most of these are now block contracts since COVID-19 began, but we also have large numbers of individual providers on specialist and general contracts, which makes it difficult to see the big picture. Specialist contracts, for example, can cover wide areas which makes it harder to pin down what is happening in each ICS. Operating with a variety of contracts like this can create significant challenges when trying to set out a whole system budget.
Use of data can help provide a greater understanding of each system
ICSs provide us with an opportunity to clarify and get on top of the metrics and to have a single interpretation within each system which will allow us to broaden our scope and incorporate areas such as mental health.
Giving full responsibility of finances to ICSs enabling them to operate the whole budget will bring many benefits and allow good population health management. However, there needs to be a shared understanding of how local services are run to ensure all areas of the system are given adequate funding. All members of the ICS need to understand how each part of the system works and it is crucial that financial decisions are based on a sound knowledge of the challenges across the whole system.
Bringing together sources of data from across community, primary and acute care can help to provide one overall picture of how the system is performing. Data can highlight where funding needs to be focused to help create change, improvement and the best patient care, as well as being able to highlight areas where proactive care can start to make a difference, but we need to tackle the finance framework and metrics first.
