NHS Better Care Fund lacks guidance, says watchdog
pharmafile | November 12, 2014 | News story | Sales and Marketing | England, NHS, UK, better care fund, nao
A much-lauded project to reduce unnecessary hospital visits and shift care into the community will fall well short of its £1 billion savings target, says the National Audit Office (NAO).
The scheme – first announced in 2013 – was designed to bundle healthcare and social services into a single £3.8 billion budget pot and as a result provide co-ordinated care – improving patient outcomes whilst also saving money.
In reality, the ambition of the plan has far outstripped its execution, according to the NAO, which notes in its report that the savings accrued are likely to be only a fraction of what was intended.
“NHS England concluded in May that the Fund plans would deliver only £55 million of financial savings, not the £1 billion the Department of Health and NHS England expected,” says the report, adding that the architects of the Fund “under-estimated the complexity and challenge of bringing together the different health and social care organisations around a single local vision in a relatively short time”.
There were also problems associated with a lack of central guidance, with local teams given the responsibility to come up with plans independently, while a mid-stage review and revisions to the scope of the programme slashed the time available for implementation by local government from 11 to five months.
At the heart of the failure is an ‘unrealistic’ expectation of a 3.5% reduction in unplanned hospital admissions, when in fact admissions have risen 47% over the last 15 years, concludes the report.
To offer value for money, the Department of Health (DH) and Department for Communities and Local Government “need to ensure more effective support to local areas, better joint working between health bodies and local government, and improved evidence on effectiveness”, said NAO head Amyas Morse.
Responding to the report, Margaret Hodge, chair of the Committee of Public Accounts, expresses her ‘dismay’ that the planning for the Better Care Fund had been ‘such a shambles’.
“It is deeply disturbing that local government believes the changes to targets and how the fund will be run move the integration agenda backward and not forward,” she adds.
NHS bodies under ‘growing financial stress’
The damning verdict on the Better Care Fund comes hard on the heels of another NAO report which concludes that the number of NHS and foundation trusts in deficit has leaped from 25 to 63 in the last 12 months, and are becoming increasingly reliant on emergency cash support from the DH, with the amount handed out rising to £511 million in the last 12 months, from £263 million in the prior year.
An increasing number of healthcare providers and commissioners are in financial difficulty, and the growth trend for numbers of NHS trusts and foundation trusts in deficit is not sustainable – according to Morse.
Until the DH can explain how it will work with NHS England and other bodies to address underlying financial pressures – quickly and without resorting to cash support “we cannot be confident that value for money will be achieved over the next five years,” he concludes.
Meanwhile, Liberal Democrat health minister Norman Lamb has told the BBC that up to £1.5 billion in additional resources for the NHS in England – with an additional block of funding for mental health services – will be needed to prevent a ‘crash’.
Without the extra funds, an increasing number of trusts will get into financial difficulty and patients will have to wait longer for treatment, he predicts.
Phil Taylor
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