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What happens when health and care systems suddenly receive several million pounds from the government and are told to spend it within three months? That is exactly what happened last winter.
With concerns that winter pressures could be exceptionally severe, the government found an extra £500 million to free up hospital capacity by reducing delayed discharges. Allocations were announced mid-November and the money started to flow in December, to be spent by the end of March. In January, a further £250 million was announced – also to be spent by the end of March.
Our research explored how six diverse areas approached this and what helped or hindered their efforts.
To work at the required pace, a triumvirate of the local authority, acute trust and integrated care board leads generally drew up a plan and drove its rapid implementation through daily or weekly meetings. In other words, the three most powerful statutory organisations called all the shots.
'We observed that the statutory partners had generally not involved the very organisations who could best help them with these aspects of their planning and managing their risks. '
Yet where areas used the funding for additional workforce capacity, it was almost invariably from the voluntary and community sector (VCS). All the statutory organisations increased capacity through existing staff working longer hours or more flexibly, but in all except one case they admitted failure in their plans to recruit additional staff.
When we asked about key risks, we often heard concerns about whether community nurses, home care services and, above all, GPs would have capacity to cope with higher numbers of patients discharged earlier. It is well known that community services are essential to reducing delays and preventing the need for hospital admissions in the first place.
We observed that the statutory partners had generally not involved the very organisations who could best help them with these aspects of their planning and managing their risks.
This is hardly a new scenario for health and care systems. It is increasingly standard practice to have short-term, ring-fenced pots of funding, including an emergency top-up for health and social care, every winter. Many local systems have developed learning about how to plan rapidly with their partners, what they wish they had done differently, and how they can assure that their decisions are not just good for hospital flow but also the best decisions for people’s quality of life.
To their credit, we should acknowledge that the government has bundled the additional funding for this winter and next into annual Better Care Fund allocations so, hopefully, we should not see this frenzy repeated in quite the same way.
'And the imbalance of power is a fact of life that can’t just be wished away, although there are ways of managing it. '
When the chips are down and health and care systems are under pressure from the centre to deliver change extremely – almost impossibly – rapidly, the big, powerful organisations need to strike a balance that will probably involve an uncomfortable compromise between taking the time to involve everyone and hitting the required pace. It is genuinely difficult in sectors with many separate, small providers. And the imbalance of power is a fact of life that can’t just be wished away, although there are ways of managing it.
Community-based health and social care providers, including the VCS, make an essential contribution to supporting people outside of hospital, and can help ensure risks are managed when people are discharged earlier with potentially more complex needs. There is a need to share learning about how to work with them at pace and avoid getting caught up in the dynamic of top-down approaches that the statutory organisations experience from the centre.
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