The Better Care Fund which was launched in 2015 in an attempt to save NHS money by ensuring that patients with long term conditions were treated properly at home has come under severe criticism by the National Audit Office. The scheme which was designed to reduce the numbers attending A&E and ensure that if people did end up in hospital they would be discharged very quickly.
In a recent report the NAO found that far from reducing numbers of emergency admissions of these patients the numbers actually went up by 87000 from 2014/25 to 2015/16. Nor was there any improvement in the bed blocking situation, where patients have to stay because there are no services for them in the community; the numbers rose over the same period costing the NHS an extra £311 million.
This meant that the Health Service spent vast amounts of money caring for patients in hospital in addition to the £5.3 million trying to treat them at home. The NOA said there was no compelling evidence that the scheme was ever going to work and some MPs described it as ‘flawed’ and ‘no more than a pipedream’.
The report added “the Fund has not achieved the expected value for money in terms of savings, outcomes for patients or reduced hospital activity despite the £5.3 million expenditure spent in 2015/2016.
Why has the fund failed to live up to expectations and what are the lessons to be learned?
In the first place it can be seen that there was far too much hype placed upon the success of the scheme and claims of prevention of admissions to hospitals unrealistic. As Amyas Morse head of the NAO said “So far the benefits have fallen far short of plans despite much effort. It will be important to learn from the over optimism of such plans when implementing the much larger NHS sustainability and transformation plans”.
Secondly, we all know by now that the lack of investment in community care services would greatly impact on the ability of the plans for the fund to prevent hospital admissions. As labour MP Meg Hillier chairman of the public accounts committee, said “MP’s warned of flaws in the fund two years ago. The focus on reducing emergency admissions to hospital without investment in community based services was bound to increase pressure on adult social care services”.
A spokesman for the Department of Heath took up a defensive position saying that “The Better Care Fund is just one element of the Governments programme to integrate health and social care for the first time. The report recognises it has already incentivised local areas to work together better with nine out of 10 places saying their plans are improving services for patients”.
It can be argued that the lack of community care services has had a major impact on the lack of success of the fund, but it seems to have been forgotten that the single plan of care drawn up jointly by health and social services did not have any plan B. That is what happens when the patient is ready to leave hospital.
We do not know from this report whether or not patients were admitted to hospitals for sickness or caring needs. Given the lack of community care services it could well have been either. What I am driving at here is the plan of care should have realistic outcomes and alternative provision planned for long term outcomes.
The Better Care Fund has not got off to the best of starts and has received criticism from the National Audit Office and MPs. I believe it would be wrong to be too judgemental in the current climate, where everyone knows that there is a lack of community care resources. The forward thinking plan of Health and Social Care Services working together has much to commend it. However, there are lessons to be learned, and in the future we will do well not be too ambitious in our expectations. The prevention of hospital admissions will not be achieved until sufficient funding is made available for community care. In future care managers should ensure that the plan of care takes account of what happens when a patient is due to leave hospital, at the moment there seems to be only one option, to stay there.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy