Has the Better Care Fund helped improve social care services?
A new report released this week by the National Audit Office (NAO) looks at health and social care integration and whether the implementation of the government’s Better Care Fund has gone any way to easing the pressures on both the NHS and community services.
As the social care crisis deepens, the outcome of the NAO’s report is not encouraging. It says that “progress with integration of health and social care has, to date, been slower and less successful than envisaged and has not delivered all of the expected benefits for patients, the NHS or local authorities”.
As a result, it warns that the government’s aim to have fully integrated health and social care services across the whole of England by 2020 was at risk of not being achieved. Amyas Morse, head of the National Audit Office says: “Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, 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. The Departments do not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”
The report shows that while the Better Care Fund, the key integration initiative, has helped in some areas with joint working between services, it’s not yet achieved its potential. Despite the £5.3 billion spent through the fund in 2015-2016, it missed its targets for the year.
One of the aims of the Better Care Fund was to help keep patients out of hospitals by improving services in the community, as well as ensure that patients are released from hospital with an appropriate care package in place at home. Since the introduction of the Better Care Fund, the number of emergency hospital admissions has gone up (by 87,000 in comparison to 2014-2015), rather than community services treating people at home bringing numbers down as hoped (by 106,000). The number of people in hospital longer than necessary due to a delay in providing the care package needed to enable them to leave, has also risen. Therefore, the planned savings of £511 million due to reduced hospital admissions have not been possible and instead it has cost £311 million more, while delayed transfers from hospital has cost a further £146 million.
The positive outcomes of the report focus on a more local level: more than 90% of local areas have agreed that delivery of their integration plan has improved overall joint working. There have also been improvements in the number of older people aged 65 and over being admitted into residential or nursing homes, and there’s been an increase in the proportion of people who remain at home more than 91 days after discharge from hospital into reablement or rehabilitation services.