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Instead of concentrating on the mechanics of joint financing and the processes of partnership, councils and the NHS should look at how their joint funding can improve people's lives, the Audit Commission says.

Means to an end: Joint financing across health and social care, out today (29 October) says outcomes should be the focus of joint working to help older people and those who need mental health and learning disability services.

Michael O'Higgins, the Chairman of the Audit Commission, says:
'Councils and their healthcare partners must agree what they want to achieve through joint funding. Pooling funds can secure improved services for patients and those in need of social care, but often the actual financial arrangements can become the focus of attention.'

'Joint funding should not be happening just for the sake of it. But there are success stories, and councils and the NHS can also achieve better value for money this way, which should be an added incentive with the financial squeeze ahead.'

Central government promotes joint working to achieve better services, but some councils and NHS bodies complain the joint funding arrangements are too complex. However, the Audit Commission's report shows where joint financing has worked and makes recommendations to councils, the NHS and the Department of Health to address concerns.

But so far, it is hard to show whether joint financing has led directly to improvement. Councils and primary care trusts (PCTs) that have joint funding agreements often lack specific, measurable outcomes to identify successes.

The report advises NHS bodies and councils to review how they provide services for health and social care users and the financial frameworks underpinning them. This December, the Audit Commission will publish the first ever Comprehensive Area Assessment (CAA), called Oneplace, identifying outcomes and showing what services are like for people living all over England.

Twenty NHS organisations (PCTs, care trusts and mental health trusts) and 15 councils took part in the research.

Among the Audit Commission's conclusions are:

• The government backs pooled funds and joint working, but not all NHS bodies and councils understand what options are available and how to make them work.
• Better joint working and improved understanding between councils and the NHS are benefits from joint financing, but they cannot be quantified. There is a lack of evidence to show the value for money from pooled funds or jointly financed services, let alone the benefits for people using services.
• Joint financing should focus on outcomes for service users rather than processes or the specific method by which the service is paid for.

Case studies

Throughout the new report, there are case studies showing joint financing arrangements that have worked, including some examples of integrated services that have not required structural change in the individual organisations (Bath and North East Somerset; Herefordshire; and Knowsley).

Torbay

In the West Country, Torbay Care Trust and Torbay Council joined forces (and funds) to improve the user experience, partly in response to a poor assessment rating for adult social care provision. To test the success of their partnership and any weaknesses in coordination between organisations, they invented Mrs Smith, a fictional older person with health and social care needs. They examined how the 'jigsaw' of health and social care services responded to Mrs Smith's needs. Also, how combined staffing (for example, using integrated health and social care coordinators as a single point of contact for users) and joint financing could improve her care. Evidence shows that users can now access services more quickly. More urgent intermediate care cases now see a therapist within four hours, while overall, 30 per cent more care packages are now in place within 28 days of assessment.

Other case studies include: Westminster; Bath and North East Somerset; Oxfordshire and Buckinghamshire; and Herefordshire.

Notes for editors

• PCTs are in charge of primary care and commission all secondary care (hospital) services. They also provide community services such as district nursing. They are now at the centre of the NHS and control 80 per cent of the NHS budget. They are local organisations and they oversee 29,000 GPs and 18,000 NHS dentists.
• Acute NHS trusts and mental health NHS trusts oversee 1,600 NHS hospitals and specialist care centres.
• CAA: From April 2009, CAA is the mechanism for assessing locally-delivered public services, bringing together judgements from six inspectorates into one coordinated view of public services in an area. The primary focus is on the place (outcomes achieved for the community and assessing the risk to future improvement) rather than on organisations and their past performance. The inspectorates will publish an annual joint assessment for every area covered by a local area agreement on the CAA website.
• The Audit Commission is an independent watchdog, driving economy, efficiency and effectiveness in local public services to deliver better outcomes for everyone.
• Our work across local government, health, housing, community safety and fire and rescue services means that we have a unique perspective. We promote value for money for taxpayers, auditing the £200 billion spent by 11,000 local public bodies.
• As a force for improvement, we work in partnership to assess local public services and make practical recommendations for promoting a better quality of life for local people.

For further information, contact Nigel Watts, Media Relations Manager, 0844 798 2129 or 07813 315538.