An analysis of joint finance in seven non-London health authorities

Joint finance is a source of National Health Service money which has been targeted by the department of Health and Social Security to be spent on community care. In particular it is to be used by agencies (statutory and non-statutory) in collaboration with the health service to facilitate the phasing out of long-stay hospital institutions by replacing these services with more appropriate facilities in the community. Joint finance has come under much criticism over the role it plays in supporting community care initiatives. The critics argue that the transitional costs necessary to support two parallel services as the balance of care shifts, involves a scale of financial support greatly in excess of that which joint finance can provide. Although this is certainly true for major transformers of resources away from institutions, this is being particularly critical of the joint finance programme. There have been limited successes obvious from this programme. Furthermore, given that the requirement of flexibility is necessary in meeting individual needs in the community, then joint finance, in relation to this range of needs has a definite supporting role. This role is, however, limited by the size and structure of the joint finance budget. This paper analyses some data from joint finance programmes in seven non-London health authorities. By analysing these data in terms of the beneficiaries of the programmes, the agencies involved, the nature of community services provided and the financial arrangements used in funding projects, the relationship between joint finance and community care is examined more closely. The results suggest that joint finance has been instrumental in pump-priming the development and improvement of day services, respite services and primary health services for elderly and mentally handicapped people. Furthermore, these service developments and improvements tend to predominate in areas of service provision for groups already living in the community requiring long-term care or for those considered at risk of future hospitalisation rather than for the direct transfer of people out of long-stay hospitals. There is no reason to believe that this role will not or would not be extended in the future to provide care for other priority groups, particularly mentally ill and physically handicapped people, who have tended to be ignored in existing joint finance programmes.