Is it just me…?

Is it just me…? Editor, Emma Morriss examines the ‘shambles’ that was the planning for the Better Care Fund and asks whether this laissez-faire approach by Government was really appropriate.

The Better Care Fund, or Integration Transformation Fund, as it was originally named, was announced by the Government in the June 2013 Spending Round. It was hailed as, ‘one of the most ambitious ever programmes across the NHS and local government, creating a local single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their well-being as the focus of health and care services.’  It aimed to deliver better, more joined-up local services for older and disabled people, caring for them in the community, keeping them out of hospital, easing pressure on the NHS and improving people’s lives.

I’ll admit, it was an exciting prospect. The concept of making integration a reality, of social care providers being in at the beginning and helping to drive, shape and deliver innovative solutions to ease the pressure on the NHS with money specifically for it, what’s not to get excited about?

The reality

However, planning has fallen short. A National Audit Office report into the Fund has concluded, ‘the quality of early preparation and planning did not match the scale of ambition’.

The organisation which scrutinises public spending for Parliament reported that, ‘Early local plans for the Fund, which will pool £5.3 billion of existing NHS and local authority funding in 2015-16, did not meet Ministers’ expectations or generate the level of savings the Government expected and all plans had to be resubmitted. Although the Government’s early planning assumption was that the Fund would save the NHS £1 billion in 2015-16, current plans forecast at least £314 million of savings for the NHS.

‘It was agreed that local areas would develop plans for spending the Fund with minimal central prescription, in order to drive local innovation from the bottom up, and reflecting the fact that no savings target had been formally agreed for the Fund during Spending Round 2013. As a result, there was no central programme team, no programme director and limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support. In addition, the initial scheme guidance did not mention the scale of savings expected from the Fund.’

But there were expectations of savings, £1 billion of NHS savings.

‘A shambles’

Margaret Hodge MP, Chair of the Committee of Public Accounts has called it ‘a shambles’. In a statement she said, ‘The integration of health and social care is fundamental to delivering more efficient and effective NHS and social care services… So I am dismayed that planning for the Better Care Fund has been such a shambles.

‘The Fund will not now deliver the £1 billion savings originally expected – savings which local areas were not initially told they should collectively deliver.’

She continued, ‘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. 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 Better Care Fund is a complex and challenging initiative that clearly requires strong leadership and effective cross-government working, both of which have been lacking. It is hard to believe that until recently there was no central management team or programme director and there were only limited attempts to identify and manage risks to successful delivery. 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.’

What’s next?

All this has left me feeling rather deflated. Local area plans for the Fund didn’t meet expectations but expectations weren’t communicated. Surely it’s not surprising then that plans fell short. Whilst I appreciate the sentiment of the laissez-faire approach, with something this ambitious looking to patch a huge hole in the NHS – surely some central Government direction and clarification of expectations were essential? Where we go from here and what this means for integration and the future of health and social care, only time will tell.

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