Tuesday’s report from the National Audit Office on Planning for the Better Care Fund painted a disappointing picture of plans containing misplaced assumptions not backed up with evidence through a lack of engagement with important stakeholders.
As a result, during the summer the process was placed on hold and targets and incentives were redesigned. Plans were not put to Ministers in April as intended because the financial risk to the NHS was regarded as far too great.
Plans have been reworked and last month we learned that 146 of the plans, the vast majority, have been approved, including those requiring further support (91) and some with certain conditions attached (49).
The Better Care Fund now contains some £5.3 billion in funding and exceeds the minimum contribution by £1.5 billion. The amount of credible savings has been adjusted down from £1billion to £532 million made up of reduced emergency admissions (£283 million), reduced delayed transfers of care (£31 million) and increased effectiveness of reablement (£30 million). The vast majority of savings appear to accrue to the NHS.
The main change was to the framework for the £1 billion payment-for-performance part of the Fund. The proportion of the £1 billion linked to performance now depends on the level of the local target for reducing total emergency admissions to hospitals.
We know all too well that there are far too many people being admitted and readmitted into hospital unnecessarily. Over 200,000 older people are readmitted into hospital within a month of discharge. Together the plans aim to deliver over one year an overall reduction in non-elective activity (general and acute) of 163,162 stays. In addition over 2 years the Fund aims to deliver 100,962 fewer unnecessary days spent in hospital, 11,860 older people remaining at home 3 months after discharge and 1,948 more people supported to live independently.
This process has been tough on local authorities. In the past few months local areas would have been preparing to implement the Fund. Instead they were reviewing and resubmitting their plans. This may impact on their performance and therefore ability to hit targets in the early stages of the Better Care Fund which may have a knock on effect on resources.
Joined up health and social care is a laudable and necessary ambition given tight funding and an increasingly ageing population. With the emphasis so strong on reducing hospital admissions, local government believes that the resources to support wider local initiatives to promote integration and prevention will be reduced. Reducing admissions by over 3% when they have risen by 47% over the past 15 years is a very ambitious target.
Providing a degree of focus and direction is a good thing and is an improvement on a vague call to pool budgets. But we must not lose the good initiatives that already exist. The dust is now settling and it is hoped that lessons have been learned and that that the Fund can deliver on its core undertaking “to give elderly and vulnerable an improved health and social system and to join up health and care services around the needs of patients, so that people can stay at home more and be in hospital less”.