House of Commons - Planning for the Better Care Fund

Planning for the Better Care Fund - Public Accounts Contents

2 Realising the objectives of the Better Care Fund

10. Local areas have now signed off plans that anticipate £532 million of savings in 2015-16, including at least £314 million for the NHS. The Departments and NHS England expect around £253 million of savings to come from reducing emergency admissions to hospital.[23] However, emergency admissions have been rising for many years and have increased by 4.9% for the first three quarters of 2014-15, compared with the same period in the previous year.[24] NHS England confirmed that, if emergency admissions do not reduce by the degree planned, 3.07% on average across England, hospitals would be paid for the higher-than-expected number of admissions from the £253 million pay-for-performance part of the Fund. NHS England also told us that if the full £253 million was insufficient, hospitals would be paid for additional admissions through the NHS's tariff payment system.[25] NHS England is currently consulting on changes to the tariff which would increase the amount paid to hospitals with increasing levels of admissions.[26] The Departments and NHS England also expect savings through reducing delayed discharges from hospital, although these are currently increasing.[27]

11. Changes to the Fund puts pressure on some local authorities' adult social care services at a time when they are already under strain. Expenditure on adult social care fell 8% between 2010-11 and 2012-13. Almost 90% of local authorities now only offer care to people with substantial or critical needs[28], and analysis by Age UK indicates that 870,000 people over the age of 65 have unmet care needs.[29] Local authorities may face additional burdens on adult social care services from recent reforms, such as: the duty to invest in preventative services; the duty to provide high-quality information and advocacy; and new rights for carers.[30]

12. Furthermore, the Departments and NHS England expect financial benefits at the same time as improved outcomes for patients. There is limited evidence that integrated care can reduce emergency admissions to hospital and even less that it can save money in the period expected. The Local Government Association has said all along that to achieve the radical transformation desired, savings should not be required at the same time as the investment.[31]

13. The Departments transferred an additional £200 million in 2014-15 to local areas to support them in preparing for the first full year of the Fund through, for example, recruiting and training staff.[32] But local areas' time for preparation has been shortened by the delays in planning, and the first quarter upon which performance-related pay will be based is January to March 2015. Even for those with approved plans, this is less than three months after the October 2014 announcement which informed areas of their plan status.[33] The Department of Health could not provide the Committee with detail about how the £200 million has been spent in local areas and we welcome the Department's subsequent commitment to provide the Committee, in June 2015, with a breakdown of how local authorities spent the money transferred to them from the NHS in 2014-15.[34]

14. The Departments and NHS England maintained that they were confident that local areas would achieve the expected reductions in emergency admissions and the £532 million savings for the NHS and local authorities.[35] However, NHS England admitted that further testing of local plans by the central bodies in the period up to March 2015 might reduce the overall target for reducing emergency admissions. NHS England agreed that factors outside the scope of local plans, such as the availability of GPs and other out-of-hospital services, might reverse some of the impact of the Fund.[36]

15. The redesign of the Fund resulted in more protection of funding for the NHS than was the case in the original design. Of the £1.9 billion being redirected to the Fund in 2015-16 from the NHS's hospitals budgets, £1 billion is now protected, in some way, for the NHS. £0.75 billion must now be spent on NHS-commissioned out-of-hospital services.[37] Each local area has estimated how its emergency admissions to hospital will change as a result of the Fund and each will receive a share of £0.25 billion, on a payment-for-performance basis, if they successfully reduce their emergency admissions according to their plan.[38]

16. These new requirements increase the protections for NHS spending. While a national condition of the Fund is that local areas should protect social care services, the condition specifically excludes protection of social care spending.[39] The NHS is still making a net contribution to the Fund, but until the redesigned version of the scheme was announced in July 2014, local authorities expected to have unrestricted access to around £1 billion more to protect adult social care than they had after the reset.[40]

17. The Department of Health told us that at the time of the hearing, only six local plans had been fully approved, 91 had been approved but had relatively straightforward outstanding actions to resolve, 49 had been approved but with conditions that will take some effort to resolve, and five had not yet been approved.[41] The Local Government Association told us that 21 plans have serious concerns and 14 still need to show how adult social care will be protected. The Committee heard that NHS England and local government colleagues have set up a team of better care advisers to provide specific support to those areas where the protection of social care is an outstanding issue and that health and wellbeing boards are working to complete their plans.[42] The Department of Health told us that in response to a September 2014 survey to establish the impact of the Fund redesign on planned social care spending: 74% of local authorities reported they had not changed their planned spending on social care as part of the Better Care Fund; 8% said there had been an increase; and 19% said there had been a decrease.[43]

23 Qq 82, 107, 149; C&AG's report, para 2.13 Back

24 Qq 106, 112; C&AG's Report, para 3.10; NHS England statistical press notice, http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2014-15/ Back

25 Qq 108-111, 121 Back

26 Q 117; http://www.england.nhs.uk/resources/pay-syst/con-notice Back

27 Q 152 Back

28 Qq 86, 88, 129; C&AG's Report, Adult social care in England: overview, Session 2014-15, HC 1102, 11 March 2014 Back

29 Q 89; http://www.ageuk.org.uk/latest-press/archive/older-people-care-needs-not-getting-help Back



© Parliamentary copyright 2015	Prepared 26 February 2015