Planning for the Better Care Fund

Public accounts Committee report: Planning for the Better Care Fund

This new report finds that, with the redesign of the Fund after April 2014, the priority has shifted from improving local services through integration to protecting NHS resources. It appears to the Committee that NHS spending was judged a higher priority than supporting adult social care.

Key comments

• The initial planning for the Fund was deeply flawed. NHS England/Department of Health assumed the Fund would secure £1 billion in financial savings for the NHS. The Department for Communities and Local Government had not worked on the basis of a required savings target and later identified savings of just £55 million when local plans were stress tested.
• The latest plans suggest that local areas expect to pool £5.3 billion and save £532 million in 2015–16 but the Committee does not believe it is possible to reduce emergency admissions and to deliver £532 million of savings in 2015–16, as the scale of the challenge in reversing the long-term upward trends in emergency admissions and delayed discharges is significant.
• It is not yet clear how all local authorities will protect adult social care services to the extent intended. At the time of the hearing, fourteen local plans presented serious concerns with regard to the protection of adult social care in those areas. Demographic changes mean demand for adult social care services is increasing at a time when available resources are shrinking, and the scale of the challenge facing local government and the NHS is growing as demand for health and care services increases.

  “All the agencies involved need to rise to this challenge as failure, particularly for older and disabled people, is not an option. The Departments should publish an annual scorecard to demonstrate the extent to which the Fund is supporting integration, maintaining adult social care, reducing emergency admissions and saving money."

Recommendations

• In future spending discussions, departments and the Treasury should unambiguously define service and savings requirements, and ensure they are clearly, consistently and transparently presented to all parties.
• When overseeing local implementation of complex and important reforms, the Departments should ensure that they clearly communicate their objectives to those responsible for delivery.
• The Departments should identify all constraints on programmes from the outset and ensure that mitigating those constraints does not undermine timely planning and the successful achievement of objectives.
• The Departments should set out, in a joint accountability system statement, the specific responsibilities and accountabilities for the Fund of all local and national partners, including for plan approvals, delivery and value for money.
• The Departments should write to the Committee at the end of February 2015 setting out whether they have resolved the outstanding issues in areas without fully approved plans, and how they will deal with any areas which have not met the national condition to demonstrate how they will protect adult social care services.
• The Departments should publish an annual scorecard to demonstrate the extent to which the Fund is supporting integration, maintaining adult social care, reducing emergency admissions and saving money.