Impact of Pooled Budgets for Children with Complex Needs: Narrative Review

Pooling of budgets should be considered in the context of effective integrated care systems, and improvements in the latter are likely to benefit the introduction of pooled budgets.
• It is important to allow sufficient time to establish both integration and the pooling of budgets.
• Outcomes should be measured that determine whether children, young people and families experience a ‘joined up’ service that identifies needs early and meets them effectively.
• There is limited evidence on the impact of pooled budgets: parents’ satisfaction with service delivery processes may be greater for integrated care systems versus usual care, and for ‘some dedicated funding’ compared with none. But neither integrated care generally, nor pooled budgets appeared to have an effect on child’s and parents’ quality of life and unmet needs.
• Legal agreements may protect pooled funds against re-allocation to other services or covering financial deficits. They can lead to better use of resources and service provision.
• Barriers to pooling budgets include protectionism of budgets, unequal funding issues, budget responsibility, separate accountancy and IT systems, time and cost to make legal agreements.
• Ways of overcoming barriers and achieving better outcomes may include: optimized interprofessional working (higher quality of relationships and good communication), legal agreements, transparency and openness over finances.
• Importantly there needs to be a clear vision and shared sense of purpose, a willingness to change, and a person-centred commitment to children and young people, and their families.