Better evidence needed about how the fund improves outcomes for service users, says Auditor General
Since the inception of the fund, the Welsh Government has made a total of £270 million available up to March 2019 and with a further £115 million allocation for 2019-20. The report finds that the fund has supported improved partnership working. But, despite some positive examples, its overall impact in improving outcomes for services users remains unclear.
The aim of the Integrated Care Fund is to drive and enable integrated working between social services, health, housing and the third sector and independent providers. The fund is distributed by the Welsh Government to seven Regional Partnership Boards (RPBs), which are aligned geographically to the seven health boards in Wales. Funded projects support people of different ages, with varying and often complex needs. The fund can support new initiatives, or extend existing ones to a broader area, with the intention that successful initiatives would be mainstreamed into organisations’ core business.
The report concludes that while the fund has supported better integrated health and social care services, there is little evidence of successful projects yet being mainstreamed into core budgets. Of the project leads surveyed, 75% identified that there were challenges in mainstreaming their project. The report also finds that the Welsh Government has not set any specific expectation on how to capture information about outcomes. While 87% of RPB members and 91% of project leads surveyed agreed that the projects funded were making a difference to service users, the Welsh Government and the RPBs recognise the need to strengthen outcome reporting and the Welsh Government intends to commission some wider evaluation work.
The report identifies opportunities to improve the way the fund has been managed and makes recommendations to the Welsh Government, working with the RPBs where relevant, around the following areas:
- Timeliness of guidance and decision making;
- Review of multiple short-term funds available to health, social care and housing organisations;
- Governance and scrutiny arrangements;
- Measurement of outcomes and general project monitoring; and
- Sharing of learning and mainstreaming of projects.
Speaking about the report, Auditor General, Adrian Crompton said:
“The Integrated Care Fund has provided an impetus for partners to develop integrated health and social services and I am encouraged by the positive case studies identified by the Regional Partnership Boards. However, aspects of the way the fund has been managed at national, regional and project levels have limited its potential to date. With the Regional Partnership Boards taking on additional responsibilities, there are lessons to learn for this and other funding streams to get things right from the outset: being clear about expectations; providing timely guidance and appropriate planning horizons; and putting in place effective monitoring arrangements.
“I am pleased that the Welsh Government has already taken action to respond to some of the issues raised during the course of my work. The Welsh Government now needs to work with Regional Partnership Boards to agree how better evidence about the overall impact of the fund on service users will be gathered and to address my broader recommendations.”
Notes to Editors:
- For its first year (2014-15), the Welsh Government focused the fund on supporting older people and helping to avoid unnecessary hospital admissions, or inappropriate admission to residential care. It also focused on preventing delayed discharges from hospital and reducing the rates of delayed transfers of care. After some continued funding in 2015-16, the Welsh Government has since extended the scope of the fund. It now includes: children and adults with complex needs; children and adults with learning disabilities; the Integrated Autism Service; carers (of all ages); the Welsh Community Care Information System and children at risk of becoming looked after, in care or adopted.
- As part of their wider responsibilities, RPBs must ensure that partner organisations work effectively together to identify needs within the regions’ population (a population assessment) under the provisions of the Social Services and Well-being (Wales) Act 2014. The creation of the RPBs under the Act replaced the seven pre-existing health and social care partnership forums, putting these partnership arrangements on a statutory footing.
- This report examines whether the fund is being used effectively to deliver sustainable services that achieve better outcomes for service users. It focuses on whether the Welsh Government is effectively managing the fund to deliver against its intentions, as well as understanding whether RPBs are demonstrating effective use of the fund. The report also considers whether the projects supported by the fund are making a clear difference at a local level.
- Case Studies: Examples of funded projects are in Exhibit 2, pages 8 – 10. Example of positive impacts of projects funded by the Integrated Care Fund can be found in Exhibit 10 on page 46. Further information is available in RPBs annual reports, many but not all of which are published on their websites.
- Survey Results: Key findings from our surveys of RPB members and project leads can be found in Appendix 5, pages 55 and 56 of the report.
- Spokespeople: English and Welsh language spokespeople are available on request.
- The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £15 billion of funds that are voted on annually by the National Assembly. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £7 billion) and to local government (over £4 billion).
- The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the National Assembly or government.
- The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.