Responding to COVID-19: insight, support and guidance
The Government’s proposals for the Better Care Fund (BCF) have been viewed with a degree suspicion from all sides. Part of the problem seems to be that obfuscation is at the heart of the whole BCF arrangement. The BCF exists partly in recognition that spending cuts in local government as a whole undermined NHS services. In its funding allocations in the Spending Review the Government protected NHS funding but undermined the ability of its partners to deliver.
The BCF is partly a mechanism for transferring money from health to local government to compensate for cuts, but to target transferring resources so that they support the “right services” rather than just to prop up local government more generally.
The uncertainty around the BCF is worrying for any local authority with adult social care responsibilities. It is still not fully clear from any of the Government announcements how the BCF will work at either the national or local level. In the spending power calculation for 2015-16 (Local Government Finance Settlement, January 2014), it was stated that the BCF would increase spending power for local government by £3.46bn but that “this funding is from within NHS budgets and the NHS and local authorities must agree locally through Health and Wellbeing Boards how the funding will be spent”. So at a national level there is a very mixed message about how\whether resources will transfer from NHS to local government, and what they will be used for.
It is understood, however, that the intention within Government is that the BCF does represent a de facto funding transfer from the NHS to local government, although it is difficult to fully comprehend the ways and means by which such a transfer will be enacted.
To help protect themselves, local authorities need formal arrangements both for the additional investment they are making in community-based services through the BCF and for the funding they need from the NHS for their overall shortfall in funding. To get the most out of the BCF, authorities are effectively in the position of making a bid to their CCG for funding: authorities should make clear the additional community-based services that will be provided (and the emergency admissions that will be avoided) and the existing adult social care services that need to be protected.