The Better Care Fund has lost credibility and will fail to generate anywhere near its projected £1 billion savings target because of significant failings in preparation and planning for its implementation in April next year, the National Audit Office has concluded.
The NAO’s report has catalogued a series of errors causing major setbacks to the delivery of the Fund – which will pool £5.3 billion of existing NHS and local authority funding next year to better integrate health and social care services – such as the absence of a central management team or programme director to lead the way.
The Department of Health and the Department for Communities and Local Government developed the Fund’s policy, with NHS England and the Local Government Association responsible for delivery and implementation. But local areas were tasked with developing tailored plans for spending the Fund with minimal central input, meaning no central programme team or programme director. Consequently, there was limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support, the NAO said, also stressing that the initial scheme guidance failed to mention the scale of savings expected.
Perhaps unsurprisingly against this backdrop, local plans failed to meet Ministers’ expectations with projected savings of just £55 million – light years away from the £1 billion targeted by the government – and so all proposals had to be resubmitted. Current plans for the Fund are now on track to generate savings of at least £314 million for the NHS, but this is still less than two-thirds of that originally expected, and the time for local authorities to prepare for implementation has now been significantly reduced, the NAO points out.
Furthermore, the Local Government Association does not agree with recent government changes to the Fund’s scope. Revisions to the £1-billion pay_for_performance part of the pot have cut the number of related indicators from six to one, and now a portion is to be paid for reducing total emergency admissions to hospitals – with local areas targeted with a 3.5% cut on 2014 levels – while the rest will be spent on NHS_commissioned out_of_hospital services.
Ambitious target
These revisions “undermine the Fund’s core purpose as promoting locally led integrated care and reduce the resources available to protect social care and prevention initiatives,” the Association argues, while the NAO notes that “expecting such reductions within one year is ambitious against a trend of rising emergency admissions and feedback from local areas suggesting that some areas will struggle to meet this target”.
The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, has expressed “dismay” that “planning for the Better Care Fund has been such a shambles”.
“Successful delivery depends on goodwill and joint commitment but delays and changes to the Fund’s design have weakened its credibility with local bodies and lost goodwill,” she said, noting that it is “deeply disturbing that local government believes the changes to targets and how the Fund will be run move the integration agenda backward and not forward”.
The BCF requires “strong leadership and effective cross government working, both of which have been lacking”, and “such incompetence from Departments is unacceptable at a time when the number of people most likely to need care is rising, and overall funding is falling,” she said.
