Scoping real world examples of pooled health and social care budgets
What were we trying to do?
We worked with the Greater Manchester Integrated Care Partnerhsip to explore and understand models and systems of integrated and pooled health and social budgets, in order to develop a functioning integrated health and social care system within Greater Manchester.
Why was this important?
National NHS bodies had suggested pooled budgets as a possible way to support local health and social care systems to deliver better integrated care. In theory, this could simultaneously result in better health outcomes for the overall population and lower costs to healthcare providers.
It was important that we looked at international literature to understand if these outcomes had been found in other locations, and to identify if there were any key barriers and influencers to developing a functioning integrated health and social care budgetary system.
How did we do it?
We took three main approaches:
- We did an international literature synthesis and mapping exercise to identify examples of pooled budgets from different health and social care environments, looking at national, regional and neighbourhood levels.
- We developed a taxonomy of pooled budgets.
- We used national and regional data related to health and social care spend and looked at the extent to which it was reactive or proactive.
Findings
Our review found that there was very little detail on the full implementation of pooled budgets, with very few examples of fully 'place-based' budgets and un the UK based literature, it was not clear whether models had already been implemented or were planned.
In international literature, it was difficult to know whether the effects seen were due to integrating funds or other delivery changes that happened at the same time.
Because of differences in health systems in the UK and other countries, it was also difficult to directly compare UK and international implementation of pooled budgets, because internationally:
- Most targeted a specific population (for example, older or high-risk adults) rather than the entire population.
- There was wide variation across the amount of money pooled, whether money was in existing or additional funds, and the range of services pooled.
There were three key considerations this review identified:
- Variations in what people need in different places influence the appropriate mix of providers and budgets. Depending on which budgets are pooled, existing allocation formulas might need to be re-considered.
- When budgets are pooled, the ‘provider landscape’ can be simplified into a single (or integrated) group, to avoid disadvantaging areas as the flow of money changes. This means that the geographical overlap of providers needs to be considered, which could be difficult when there is not clear overlap.
- Pooled budgets address the commissioning side of policy but it is not clear how much the outcomes at a system and population level can be changed by pooled budgets alone. Provider behaviours and population outcomes need to be changed by examining expenditure/provider/incentives.
Overall, there was limited evidence of improved outcomes from pooling budgets, particularly in the short-term.
Who did we work with?
Downloadable resources
More information
Senior Programme Lead
Mike Spence