How responsible financial frameworks can improve choice and control in care

Local authorities and NHS service managers know the drill. Any time there’s a requirement for a new piece of equipment – a new computer perhaps, a connected group of printers or televisions for a meeting room – then the procurement team will source the equipment, a requisition will be placed, followed by a Purchase Order, Goods Received Note and finally an invoice. All of these things will need to match in order for the payment to be approved. And it may only be for £100, but it’s a necessary part of any recognisable good practice for most businesses.

Now, imagine spending £25m on something, with no real idea whether it’s been delivered, or how much of the requisition was actually spent by the agreed supplier on the services or goods that were required. This is the exact issue most funders have at the moment when they pay for personalised, community delivered care. 

One commissioner admitted to us recently that the whole system of funding and delivering personal health care budgets relies almost entirely on trust. In an ideal world, that might work. But in care, where money is tight and demand is high, it’s becoming increasingly difficult to see how that way of operating is sustainable.

It would be like agreeing to pay £10,000 for ten laptops and finding out one was in use, four had problems with the operating system, three had limited functionality and two had just not turned up – and still paying the invoice. 

This, incredibly, is how much oversight most commissioners have into the activity and expenditure on the personal health budgets they pay for. Based on our research, less than 10% of budgets are audited, often using bank statements and paper timesheets. which only tells you that the money has been spent, not on what it has been spent on. 

Choice and control has actually been lost as people, providers and funders find themselves unable to manage the financial aspects of care delivery.

And while there’s a concern that more oversight into how the money for care packages is spent might diminish people’s right to choose and control their support, that’s just not true. Choice and control has actually been lost as people, providers and funders find themselves unable to manage the financial aspects of care delivery. 

But within a responsible financial framework, it’s perfectly possible for people to have choice and control and receive the consistent care they need, want and deserve. You don’t have to lose control of the money to give choice and control in care. 

This is why Alocura is working with local authorities on pilot projects across the country to get the kind of oversight, reporting and control on multimillion pound care budgets as you would for a set of ten laptops.

Alocura can enable commissioners and funders to gain full visibility of activity and expenditure on a personal health budget by installing Rostrata in the operating systems of care providers with whom they want to have an open book framework. 

It’s a clever end-to-end cloud-based software system where commissioners and providers can see every financial transaction in a care package – and exactly what it has been spent on. 

With Rostrata, not knowing how 90% of the care packages you fund are operating or performing is a thing of the past. In one of our pilots, Rostrata actually found £250,000 in unspent budget from one year alone across several packages that could be returned to the commissioner for reallocation or even direct cashable efficiency.

Of course, responsible financial management of care budgets isn’t all about systems. Commissioners should think hard about policy in these areas and the impact of budget value and complexity on the type of mechanism they deploy.

But having immediate oversight into all aspects of personal health budgets – including, with Rostrata the ability to sync with the individual’s NHS number and Digital Social Care Records – does allow commissioners to rethink the pervading ‘more care is better care’ philosophy and focus much more on the quality of outcomes delivered through the care plan, while still finding additional efficiencies. 

Like we say, people can still have choice and control of care within a more responsible financial framework. And if care providers can concentrate on providing sustainable, long term and quality care, then everyone will benefit. 

If you’d like to talk with us about Rostrata, or how Alocura can help your financial framework, please get in touch.