Back in December 2015, the former Minister for Communities and Local Government Greg Clark pledged an additional £1.5bn to be given to councils, phased in from 2017, to expand the Better Care Fund. This signalled that the government was listening to concerns over whether the fund would be able to achieve its aims. Although it’s too early to tell how much difference the financial boost will make, to what extent is the BCF now working as hoped?
Prior to that funding announcement, CIPFA was just one of the organisations to highlight that the BCF was unlikely to achieve what the government intended. In a joint survey with the HFMA, 48 NHS bodies and local authorities, which represented £3.6bn of the total fund, were interviewed on how they felt the BCF was working six months in. They shared serious concerns that the BCF was struggling with the imposition of unrealistic targets and too much red tape which they felt could impede the achievement of meaningful impact.
However, the survey did find that, despite the problems, relationships between organisations were already starting to improve. This, of course, was encouraging news considering that the idea behind the BCF was to bring together health and social care services.
Now, after the first full year of what the government has now pledged as a long term programme, CIPFA and the HFMA have conducted another survey to see what progress has been made and whether the issues highlighted in the first survey had been resolved.
Promisingly, the amount of red tape that organisations were struggling with has been reduced going forward into 2016/17, with more appropriate targets and less central monitoring. In terms of relationships, the feedback was also positive. In the majority of cases, the BCF improved working relationships between local authorities and NHS bodies.
But, despite the general direction of travel being towards closer collaboration, there are some issues identified in the survey. One is that in some instances organisations felt that the BCF was being held back by poor finances, so that it must be used to support existing services rather than develop new ones. However, although this is a problem for delivering the BCF’s stated goals, it doesn’t undermine the value of the fund to local health and social care economies.
Another issue to emerge is that, operationally, the objective of reducing unplanned hospital admissions has been the hardest to achieve. Considering that the targets the BCF were given were far too ambitious in the first place, this news was not surprising. Because of this the government has reduced its emphasis on these targets and has implemented a more flexible approach.
So, all in all, the BCF seems to be working reasonably but there is still more that should be done to really seize the opportunity. This includes continuing to simplify the framework where possible, and integrate the BCF into plans for full integration of health and social care by 2020. If those actions are in place, the Better Care Fund will stand to save more money, time and most importantly lives.