What is the Better Care Fund?
The main aim of the Better Care Fund (‘BCF’) is to transform local services in order to ensure that people are provided with better integrated care and support, and in doing so, help local areas to manage the common pressures within this sector and improve their own long term sustainability.
By facilitating the integration of care and support, it is hoped that this will enable health services to improve the lives of some of the most vulnerable people in society and give them more control over their own care and support. Ultimately, it is hoped that the BCF will help health services to offer service users a better quality of life. The BCF will also build upon the work that is already being carried out by Clinical Commissioning Groups (‘CCGs’) and councils, by making the most appropriate care for each individual more accessible.
What is included in the Better Care Fund?
The BCF comprises of £3.8bn of funding in 2015/2016 to be spent locally on health and social care in order to achieve the aforementioned aims. In 2014/2015, along with the £900m transfer already planned from the NHS to adult social care, a further £200m will be made available in order to assist localities with laying the necessary groundwork ahead of the BCF in 2015/2016. However, this money will only be given to councils that have jointly agreed and signed off two-year plans for the BCF.
Whilst there are no new requirements for the pooling of budgets in 2014/2015, the requirements for the use of the £200m are the same as those outlined within the guidance from the Department of Health to NHS England (December 2012) on the funding transfer from NHS to social care in 2013/2014:
- The funding must be used to support adult social services in each local authority, which also have a health benefit
- Each local authority must agree with its local health partners how best to use the funding within social care, and the results that they hope to achieve from this; and ‘Health and Wellbeing Boards’ will be the natural place to discuss with NHS England, CCGs and councils about this
- Councils and CCGs must have regard to the Joint Strategic Needs Assessment for their local population, and existing commissioning plans for both health and social care, when deciding how the funding should be used
- Local authorities, councils and CCGs must demonstrate how the funding will appreciably have a positive impact on social care services and the outcomes for service users
The BCF includes £130m of NHS funding for carers’ breaks, and £300m of NHS funding for re-ablement services. Local plans will therefore need to set out the level of resource that will be dedicated to carer-specific support, and local plans will also need to show a continued focus on re-ablement.
Also, the BCF includes funding for costs to councils resulting from care and support reform. Whilst this money is not ring-fenced, local plans should show how the new duties are going to be met.
How should councils and CCGs develop and agree a joint plan for the Fund?
A condition of accessing the BCF’s money is that CCGs and councils must jointly agree plans for how the money will be spent, and these plans must meet certain requirements. Each statutory Health and Well-being Board will then sign off the plan for its constituent councils and CCGs. In doing so, it will be necessary to ensure that the Fund is developed as a fully integral part of a CCG’s wider strategic and operational plan, and the unit of planning chosen by a CCG must be consistent with the boundaries of the Health and Well-being Board (or Boards) with which it works.
Whilst the specific priorities and performance goals in the plan are reserved for each locality, it is recommended that each locality:
- a) Aggregates the ambitions set for the BCF across all Health and Well-being Boards
- b) Assures that the national conditions have been achieved
- c) Understands the performance goals and payment regimes that have been agreed in each area
The six national conditions, as mentioned above, are as follows:
- The plans must be jointly agreed by the constituent Councils, the Health and Well-being Board and the CCGs
- The plans must include an explanation of how local adult social services will be protected within their plans
- The plans must confirm how they will provide 7-day services to support patients being discharged and prevent unnecessary admissions at weekends (or otherwise, why their plans will not be able to provide such services)
- The plans must secure better data sharing between health and social care, based on the NHS number
- The plans must ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an accountable professional
- The plans must identify what the impact will be on providers in their local area, including if the impact goes beyond the acutesector
The general consensus is that the BCF represents the best opportunity yet for local services to collaborate in order to improve the health and lives of people within their communities The flexibility and scope for tailoring the delivery of local services that has been given to local authorities, CCGs and care and support services when formulating their operational plans under this model is especially appreciated. It is hoped that the scope given to innovation and creativity here, when producing ambitious health and social care programmes, will be particularly important when bringing about important change for the lives of many service users. The ultimate aim of the model is thus to achieve a ‘seamless pathway of care that delivers the best possible health outcomes for people’ (Jon Rouse).
Whilst the overall direction of moving to integrated models of care and pooling health and social care budgets has been widely supported, the following risks have been identified about the model (The Guardian).
Firstly, the fund is not comprised of any new or additional money. The money contained within the BCF is derived solely from NHS and social care budgets. Therefore, unless the new integrated models of care supported by the BCF deliver equivalent benefit straight away, it is feared that the service being delivered to patients will be worse. A further concern within the scheme relates to the apparent inconsistencies regarding funding. Whilst, on the one hand, councils have been told that their spending power will be unaffected, because the £3.8bn will be spent on local authority services, the NHS has also been told that the protection of their funding will be maintained. Both cannot be correct. Also, many regard this scheme to be a huge risk given the scale and speed with which it is being undertaken, without significant additional investment, nor any assurance that these new models are working well before the old models have been discontinued. It must also be conceded that whilst integrated care models will undoubtedly produce better outcomes for patients, there is little guarantee that they will also be more cost-effective and efficient.
Further, whilst this scheme is predicated on a collaborative approach that has already been seen within certain local health and social care economies, there is no guarantee that similarly prosperous partnerships will be engendered across the scheme on a large scale. If, for example, the scheme begins to be consumed by doubt as to whether a truly integrated model can be achieved, riddled by division between health and social care over scarce funds, and overcome by a wholly adversarial environment as service deliverers seek to protect their corners, it is unlikely that the BCF will be able to achieve its overriding aims.
A final concern relates to potential risks to the NHS service delivery, resulting from taking £2.1bn out of mainstream NHS service delivery. Sir David Nicholson has told CCGs that the fund will require savings of over £2bn in existing spending, implying an extra productivity gain of 2-3% across the NHS as a whole in 2015/2016. Given the clear difficulties in achieving 4% savings a year, increasing this to 6-7% seems to be immensely over-ambitious.