Key points

  • Pathway Funds have the same purpose as the FTA: to allow funding to flow from specialised services to local health and care systems, funded by reducing reliance on specialised inpatient services.
  • However, unlike the FTA, there is no longer a formula based on a defined amount per net inpatient reduction. Instead, Pathway Funds will be linked to actual savings released by specialised providers as the reliance on inpatient care is reduced, and capacity is withdrawn.
  • As was the intention with the FTA, these savings will be reinvested in community support and services along someone’s care pathway, but it will now be up to local systems through a Pathway Panel to decide what the savings should be invested in, (as long as the investment targets community services and support for people with a learning disability and autistic people.)
  • Pathway Panels have an opportunity to transform local health and care services to drive up quality of care and tailor service provision to better suit the needs of people in their local areas.
  • Each area will have the flexibility to determine the panel’s membership but experts by experience and voluntary sector organisations will be represented. Not only will experts by experience and voluntary sector organisations be members of Pathway Panels but they will be directly involved in decision making. They will be jointly and equally involved in developing a Pathway Strategy which sets out how to reduce the number of adults with a learning disability or autism in inpatient settings, the scope for releasing funds and the plan for reinvesting in alternatives to inpatient care, which should target investments in community services.
  • Pathway Panels are required to make publicly available online a short accessible feedback report at the end of each financial year, reflecting on the previous 12 months. The report will confirm what the panel’s priorities were for the year, based on its Pathway Strategy and what action has been taken to deliver them.
  • By ensuring there is a mix of skill sets and experience around the table, NHS-Led Provider Collaboratives and their partners on the Pathway Panels will guarantee the voices of people with lived experience inform investment decisions about how to best support adults with a learning disability or autism to remain well in the community, close to or in their home.
  • To ask questions about this change Councils, Clinical Commission Groups CCGs, Transforming Care Partnerships you can email england.providercollabs@nhs.net
  • The DHSC national team working on these changes is developing briefings for:
    • People with a Learning Disability and Autistic people, their families and carers
    • Learning disability and autism third sector organisations

More information about how you can get involved will also be available from April 2021, once the Provider Collaboratives go live. Once further information is available, we will add these briefings to this webpage as they become available.

For further information or support on this topic please contact chip@local.gov.uk

Frequently asked questions

Who was involved in the review of Funding Transfer Agreements?

The Review of the FTA drew together representatives from the NHS, Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS) and the voluntary sector and was co-produced with Experts by Experience. The principles of the Review included transparency, integration of funding streams and risk sharing, and an acknowledgement that whatever replaced the FTA needed to accommodate differing local circumstances and improve local accountability.

What is a provider collaborative?

As detailed in the NHS Mental Health Implementation Plan, an NHS-led Provider Collaborative is a group of providers of specialised mental health, learning disability and autism services who have agreed to work together to improve the care pathway for their local population. They will do this by taking responsibility for the budget and pathway for their given population. The Collaborative will be led by a Lead Provider, who will be an NHS Provider. The Lead Provider remains accountable to NHSE/I for the commissioning of high-quality specialised services.

Provider Collaboratives and local Transforming Care Partnerships (TCPs) share the same aims in that they aim to reduce how many people go into specialised hospitals and spend money on community alternatives for people with a learning disability and autistic people. It is vital that Provider Collaboratives, TCPs and Integrated Care Systems work together to plan how people who do need to go into hospital get care, and to commission community alternatives.

How will a provider collaborative work?

It is expected that CCGs, Local Authorities and Provider Collaboratives will use their combined resources together to invest in community models of care, and that any decision-making around service planning and investment should include all partners equally, together with the voluntary sector and Experts by Experience.

This new way of working supports the ambitions of the NHS-Led Provider Collaborative programme, which is to ensure that people with specialist mental health needs, people with a learning disability and autistic people are able to access high quality, specialised care as close to home as appropriately possible and that care is connected to their community.

How will the voluntary sector be involved?

The voluntary sector has a critical role to play on Pathway Panels and participated in the FTA review. For people with a learning disability, and autistic people, local authority social care is critical, and the voluntary sector is a rich source of innovative, personalised support. Whilst which voluntary sector organisations should be represented on Pathway Panels have not been mandated, due to local variation in provision, Panels should be innovative in their approaches. This should involve developing a greater role for the voluntary sector within local Provider Collaborative footprints.

How will experts by experience be involved?

NHS-Led Provider Collaboratives are required to demonstrate sound understanding of the population they serve and inequalities their population experiences, along with plans to best serve their population and tackle inequalities experienced. Experts by Experience have been involved in the selection of NHS-Led Provider Collaboratives and in developing an impact framework which will be used by NHS-Led Provider Collaboratives to demonstrate their impact on key outcomes identified as important to people who use services. Including Experts by Experience on Pathway Panels provides another opportunity to ensure NHS-Led Provider Collaboratives are commissioning high quality services that suit the needs of those that use them.

What will the main sources and applications of funding be under the new arrangements?

From 1 April 2021, it is important to remember that the primary sources and applications of funds available to all system partners remain largely the same.

Sources of funds are essentially either:

  • released from Specialised Commissioning, via past FTA or Pathway Funding future arrangements, as people are discharged/beds are closed or
  • released from CCGs’ previous spending on inpatient services as people are discharged/beds are closed or
  • from CCGs’ spend, or potential spend, on people eligible for Continuing Healthcare (CHC) and S117 mental health aftercare funding in community settings or
  • from councils spend, or potential spend, to meet their statutory duties to this group of people.

Applications, or agreed areas of spend from this funding are essentially:

  • packages of support for “dowry-eligible” people, we continue to see this as the first call on funding
  • other packages of support in the community for people not dowry eligible.
  • CHC and s117 mental health aftercare funding contributions
  • community services with a specific purpose in preventing hospital admission for people with a learning disability, and or autism, for example intensive support services.

The concept of a dowry payment is focussed on providing financial support for social care costs for eligible dowry patients (five years continuous in-patient). Dowry funding can be accessed only at the point of discharge and has to be agreed locally.