Examining the Better Care Fund, which has pooled £5.3bn from councils and the NHS in an effort to better coordinate services, the NAO said progress had been slower than expected and deemed the project to be “at significant risk”.
The government believes that by bringing together health and social care and pooling budgets for these services, efficiency can be increased, improving outcomes for patients.
However, the Better Care Fund, which is the government’s principal integration vehicle, has yet to achieve its potential, auditors found. It is not providing value for money, in terms of savings, outcomes for patients or reduced hospital activity – against the £5.3bn spent through the scheme in 2015-16.
Moreover, the fund missed its principal financial service targets for its first year in 2015-16. Planned reductions in rates of emergency admissions were not achieved, and it did not achieve the planned savings of £511m.
Compared with 2014-15, emergency admissions increased 87,000 compared with a target of 106,000, which cost £311m more than planned. Also, days lost due to delayed transfers of care increased by 185,000 against a planned reduction of 293,000, which cost £146m more than was anticipated.
However, the auditors found the fund had achieved some success in incentivising local areas to work together. The report cited government polling that suggests 90% of local areas agreed or strongly agreed that the scheme had improved joint working. Also, the scheme has achieved some success in reducing the numbers of elderly people admitted to nursing and care homes, the NAO said.
Commenting on the report, auditor general Amyas said: “So far, benefits have fallen far short of plans, despite much effort. It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans.”
The report cast doubt on the assumption that integration could save money. It found “no compelling evidence to show that integration in England leads to substantial financial savings or reduced acute hospital activity.”
Morse added that the government and health services do “not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”
Responding to the report, Jane Payling, the head of health and integration at CIPFA, said that service integration is a no brainer for patients, families and stretched NHS teams.
“The introduction of the Better Care Fund as a means to integrate services was widely welcomed. However, it was always unlikely to achieve its desired first year outcomes due to the ambitious targets built in, combined with overall budget reductions,” she stated.
“It is encouraging that the government has now made its expectations of the BCF more realistic. CIPFA fears that the same mistakes could be being made with NHS’s Sustainability and Transformation Plans, as proposals may be over-optimistic and unachievable. It is critical then to revisit the deliverability of STPs before they unravel.”
Chris Ham, chief executive of The King’s Fund, agreed with the NAO’s assessment that place-based planning and health and social care integration were laudable aims.
However, “if these ambitions are to be realised, barriers to integration such as misaligned financial incentives and different planning cycles must be removed.
“Sufficient time must be allowed to build the relationships on which partnership working depends, and to deliver measurable improvements in care,” Ham concluded.
