Talk:Better Care Fund

Proposed changes

Information to be removed: The Better Care Fund is a pooled budget, initially £5.3 billion announced by the Cameron Government in the June 2013 Spending Round. Local councils are allowed to increase the local fund. The intention is to shift resources into social care and community services from the NHS budget in England and so save £1 billion a year by keeping patients out of hospital.

Each of the 151 health and wellbeing boards is required to produce a local plan, and these plans are checked by NHS England. Analysis of the plans submitted showed that social care would benefit from the fund by about £2 billion. This is four times the amount projected for hospitals to save from reduced activity.[1]

The National Audit Office said in November 2014 that the plans had been inadequately thought through and were based on “optimism rather than evidence”. There was no evidence that showed that integrated care reduces unplanned hospital admissions.[2]

Francis Maude praised Inclusion Healthcare at a speech in December 2014 about the Fund saying the company could provide care more cheaply and simply than the NHS. He said the fund was unlikely to lift the pressure from overcrowded hospitals because of “endless process and bureaucracy” in the NHS. He related how Inclusion had helped a homeless man with leg ulcers who was refusing to go into hospital because he could not afford to put his dog in kennels while he was there by writing "a cheque for £200 or whatever it cost to have the dog vaccinated and put into kennels".[3] According to Maude, the firm say "actually if we had still been in the NHS we could never have done that without endless process and bureaucracy and auditing and which budget does it come out of, and how do we account for it, and it would never have happened”.[4]

The Chartered Institute of Public Finance and Accountancy and the Healthcare Financial Managers Association surveyed the ambitious plans for saving money through integration financed by the BCF in December 2015 and concluded that 80% were likely to fail and that many were hampering progress, and “giving integration a bad name”. Targets for reduced hospital admission had generally not been delivered.[5]

In February 2017 the National Audit Office produced a report saying that the £5.3 billion spent in 2015/16 had not delivered value for money. Emergency hospital admissions had increased by 87,000 between 2014/15 and 2015/16, rather than the planned reduction of 106,000, which had cost an additional £311 million. Delayed transfers of care increased by 185,000 days, rather than the planned reduction of 293,000, which had cost £146 million more. [6]

Information to be added: The Better Care Fund (BCF) is a Government programme aimed at meeting the challenges of integrating health and social care in England in order to keep people healthy for longer. Each year, the programme establishes a pooled budget between the NHS and local authorities, with a focus on improving the integration between health and care services and housing in each local community. The Fund was announced in 2013 by the Cameron Government with an initial minimum fund of £3.8 billion. This included the Disabled Facilities Grant (DFG), a capital grant paid from the Ministry of Housing, Communities and Local Government to local authorities in England to adapt older and disabled people’s homes to help them to live independently and safely. From April 2017 the improved Better Care Fund, a local authority social care grant, was introduced and required to be pooled in the BCF. In 2019-20, the mandatory minimum allocated to the BCF was £6.4 billion. Local areas can make also voluntary additional contributions to local funds and in 2019-20, a national total of £9.2 billion of health and social care budgets were pooled.

The Better Care Fund is a partnership between NHS England, the Ministry of Housing and Local Government (MHCLG), the Department of Health and Social Care (DHSC) and the Local Government Association (LGA).

Better Care Fund Plans are agreed by local Health and Wellbeing Boards which are then reviewed by health and local government partners regionally before formal approval by NHS England. Plans are part of the local democratic process ensuring they can be linked to other public services, including wider housing, leisure and public health services.

The Better Care Fund has faced challenges both nationally and locally which has led to some perceiving the Fund to fail to reach its objectives. However, the Department of Health and Social Care in 2019 set out that the BCF has been effective in helping to keep people living independently at home, providing joined-up reablement services, reducing delayed discharges across the system and achieving closer working between the NHS and social care services.

Responsibilities

The Better Care Fund is responsible for supporting the successful delivery of integrated health and social care at a local level by:

• Promoting a joint approach to identify and assess common problems in local areas and encouraging cross-system collaboration and user engagement

• Requiring local systems to produce plans for integration

• Providing support to local systems to implement their plans

Challenges

Since its inception, the Fund has faced challenges around funding, planning requirements and implementation agreements. This is due to delays in decision-making around the policy, planning, assurance and financial settlements, which have impacted local planning. The King’s Fund have suggested that to overcome this and ensure successful integration, the Better Care Fund must develop a shared narrative between its partners.

The National Audit Office in 2014 argued that the plans had been inadequately thought through. In February 2017, the National Audit Office (NAO) produced its second report on the BCF which suggested that the progress of integration and health and social care had been slower and less successful than envisaged, and had not delivered all of the expected benefits for patients, the NHS or local authorities. It also concluded that the £5.3 billion spent in 2015-16 had not delivered value for money. However, the report concluded that the BCF was successful in boosting work between local areas with over 90 per cent of local areas agreeing or strongly agreeing that delivery of their plan had improved joint working.

' Achievements'

The Policy Research Unit on Quality and Outcomes of Person-Centred Care (QORU) carried out a detailed evaluation of the Better Care Fund in 2018 and found that, overall, the Fund has improved integrated working between health and social care.

In their Adult Social Care Funding and Integration survey in 2018, the LGA found that almost nine out of 10 respondents (89%) felt that the Better Care Fund had been fairly or very helpful in joining up care and support locally. It also found that 84% of respondents viewed the BCF as either moderate or to a great extent, a key driver of local care integration.

Explanation of issue: COI declaration: I am an NHS England employee working on the Better Care Fund and am updating this Wikipedia page as a public resource which displays misleading, out of date information. The article is misleading in that it selectively uses information and sources that portray the subject topic in a negative light. My proposed edits to the article, which retains the original sources and content, contains much more up to date, fully referenced information which provides a more accurate and balanced view

Autumnleaves678 (talk) 12:11, 27 October 2020 (UTC)

• Your proposed changes mostly seem to rely on primary, official, sources. I dont think we should lose the older secondary sources, but they need to be augmented with more up to date material. Rathfelder (talk) 23:54, 27 October 2020 (UTC)
• I've endeavoured to integrate the new content, and included more wikilinks. Rathfelder (talk) 10:29, 28 October 2020 (UTC)

• Attempts have been made to incorporate more up-to-date material, keeping both original sources and adding those which include more accurate information. I've endeavoured to structure the article so that it is more accessible to readers and reflective of the topic. Autumnleaves678 (talk) 09:30, 27 November 2020 (UTC)

References

Proposed changes

Text to be removed: The intention was to shift resources into social care and community services from the NHS budget in England and so save £1 billion a year by keeping patients out of hospital.

Reason for change: This statement is not sourced and there is no evidence for this claim. The information is also misleading as the previous sentence states the true intentions of the Better Care Fund, i.e. "to meet the challenges of integrating health and social care in England in order to keep people healthy for longer".

Text to be removed: The pooled budget includes the Disabled Facilities Grants. Text to be added: The pooled budget includes the Disabled Facilities Grants, a capital grant paid from the Ministry of Housing, Communities and Local Government to local authorities in England to adapt older and disabled people’s homes to help them to live independently and safely.

Reason for change: No evidence for this claim. The changes include a sourced claim.

Text to be removed: The National Audit Office said in November 2014 that the plans had been inadequately thought through and were based on “optimism rather than evidence”. There was no evidence that showed that integrated care reduces unplanned hospital admissions.

Text to be added: The National Audit Office in 2014 argued that the plans had been inadequately thought through. In February 2017, the National Audit Office (NAO) produced its second report on the BCF which suggested that the progress of integration and health and social care had been slower and less successful than envisaged, and had not delivered all of the expected benefits for patients, the NHS or local authorities. It also concluded that the £5.3 billion spent in 2015-16 had not delivered value for money.

Reason for change: The statement is out dated and includes information from a report that has since been updated. The new text includes more up-to-date information that is less biased and presents a more accurate understanding of the subject matter.

Text to be added: The Policy Research Unit on Quality and Outcomes of Person-Centred Care (QORU) carried out a detailed evaluation of the Better Care Fund in 2018 and found that, overall, the Fund has improved integrated working between health and social care.

Reason for change: includes up-to-date and relevant information that the original is missing.

Explanation of issue: COI declaration: I am an NHS England employee working on the Better Care Fund and am updating this Wikipedia page as a public resource which displays misleading, out of date information. The article is misleading in that it selectively uses information and sources that portray the subject topic in a negative light. My proposed edits to the article, which retains the original sources and content, contains much more up to date, fully referenced information which provides a more accurate and balanced view Autumnleaves678 (talk) 09:58, 30 October 2020 (UTC)

• Attempts have been made to ensure the article has up-to-date sources and material. I've also re-structured the article to present a clearer, more representative, picture of the topic. Autumnleaves678 (talk) 09:31, 27 November 2020 (UTC)

References