Funding fragmentation threatens integration of NHS care

An increasingly fragmented funding allocation system risks undermining the government's emphasis on integrated care, a report has concluded.

King's Fund: fragmented funding threat to integrated care
King's Fund: fragmented funding threat to integrated care

The King's Fund report on health resource allocation found recent reforms such as splitting public health and NHS funding and the new role for NHS England in resource allocation, created a ‘strikingly more fragmented’ system.

It also warned that the system would become increasingly fragmented as the number of commissioners increased, posing ‘substantial risks to a system that needs to integrate around whole care pathways and populations’.

‘There is as yet no sign that the DH is addressing these risks,' the authors warn.

David Buck, senior fellow at The King’s Fund and co-author of the report, said: ‘Recent reforms bring major changes to resource allocation, risking confusion and complexity. As the funding squeeze bites, it is crucial that we think carefully about how and why health spending is allocated.

Mr Buck welcomed NHS England’s 'fundamental review' of the allocation formula announced last December as an oportunity for debate on what that allocation should achieve in future.

The report calls for the review to assess whether allocation should be increasingly based on outcomes or more explicitly linked to clinical standards.

It adds: ‘Above all, the fundamental review must address this question: is resource allocation simply a mechanism for moving centrally collected funds to local areas, or is it a tool for achieving wider policy goals?

'If it is the former, this could suggest a return to a much simpler approach since the complexity does not seem to be making much difference to final target allocations. But if it is accepted that resource allocation is, or should be, a policy tool then a much more fundamental review is called for.’

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