By Judith Ugwumadu | 11 November 2014
Early plans to integrate local health and social care services through the Better Care Fund are ‘inadequate’ and fail to match the scale of its ambition, the National Audit Office warned today.
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The £5.3bn Better Care Fund has been designed to join up local services to reduce accident & emergency admissions and the length of stay in hospitals for old and disabled people. It is due to be introduced in April next year but initial plans did not meet ministers’ expectations or offer the level of savings expected. As a result, NHS England resubmitted the plans to government in April this year.
Initial local plans had assumed that the Better Care Fund would save the NHS £1bn in 2015/16. It was agreed that the local areas would develop plans for spending the fund with minimal central instruction, but this resulted in ‘no central programme team, no programme director and limited risk management and no analysis of local planning capacity’, the NAO concluded.
Additionally, the initial scheme guidance failed to mention the scale of savings expected from the fund.
Now current savings are forecasted at £314m in 2015/16 – less than two-thirds of what was originally expected, the public spending watchdog added.
NAO head Amyas More said ministers were right to pause and redesign the scheme in April this year when they realised it would not meet their expectations.
He said: ‘The £1bn financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government’s confidence in the fund’s value.’
Despite this, the fund still contained bold assumptions about the financial savings expected in 2015/16 from reductions in emergency admissions, he added.
‘To offer value for money, the [departments of health and communities and local government] need to ensure more effective support to local areas, better joint working between health bodies and local government, and improved evidence on effectiveness.’
In July, the departments revised and improved the Better Care Fund’s governance and programme management, requiring local areas to submit new plans in September 2014 for expected approval in late October.
Under the fund’s revised conditions, local areas were asked to aim for at least a 3.5% reduction in their total emergency admissions over 2014 levels. The NAO said such reductions within one year were ambitious against a trend of rising emergency admissions. Local areas have proposed reductions of 3.1%.
Public Accounts Committee chair Margaret Hodge said she was ‘dismayed that planning for the Better Care Fund has been such a shambles’.
‘The integration of health and social care is fundamental to delivering more efficient and effective NHS and social care services to meet the growing needs of our population,’ she said.
‘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.’
She also noted that the assumption that local areas could achieve a reduction in emergency admissions of 3.1% was ‘a triumph of hope over reality’.
The Department of Health said it disagreed with the criticism of the early stages of the programme.
A spokesman said: ‘This is the most ambitious plan to transform care ever undertaken and we ensured detailed work took place a year ahead of the launch to allow us time to iron out the issues that the NAO itself now acknowledges have been addressed.
‘Last month over 97% of local areas had their plans approved, ensuring that people will be able to get seven-day care services that work for them and saving an estimated half a billion pounds of taxpayers' money too.’
Nuffield Trust chief executive Nigel Edwards added that the trust had warned about the over-optimistic assumptions of the Better Care Fund before.
‘Reducing emergency admissions to hospital is very difficult. Even where it works, it takes a long time and doesn’t necessarily save money.’
