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NAO report: a 'wake-up call' for government

Plans to squeeze billions from NHS budget by shifting care into community “built on sand”

Louise Prime

Wednesday, 08 February 2017

The government’s plans to squeeze billions from the NHS budget by shifting care into the community are built on sand, Nuffield Trust warned this morning – as the National Audit Office reported that integration of health and social care has so far failed to deliver the expected benefits for the NHS, local authorities or patients.

The NAO’s report into health and social care integration revealed that the principal integration initiative, the Better Care Fund, has over its first year improved joint working but achieved very few of the expected benefits. It found that integration has progressed more slowly, and been less successful, than envisaged by government ministers – putting at "significant risk" the government’s plan to have integrated health and social care services across England by 2020. It said the relevant government departments are failing to address identified barriers to integration. And it warned that NHS England’s ambition to make huge savings through new care models "may be optimistic".

The NAO reported that:

  • The Better Care Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity, from the £5.3bn spent through the Fund in 2015-16.
  • Nationally, the Fund did not achieve its principal financial and service targets over 2015-16. Planned reductions in rates of emergency admissions were not achieved, nor did the Fund achieve the planned savings of £511m. Compared with 2014-15, emergency admissions increased by 87,000 against a planned reduction of 106,000, costing £311m more than planned. Days lost to delayed transfers of care increased by 185,000, against a planned reduction of 293,000, costing £146m more than planned.
  • The Fund has been successful in incentivising local areas to work together; more than 90% of local areas agreed or strongly agreed that delivery of their plan had improved joint working.
  • Despite general agreement that place-based planning is the right way to manage scarce resources at a system-wide level, local government was not involved in the design and development of the NHS-led sustainability and transformation planning (STP) programme; although four STP areas are now led by local authority officials.
  • The Department of Health and the Department for Communities and Local Government are not systematically addressing identified barriers to integration, such as misaligned financial incentives, workforce challenges and reticence over information sharing.
  • NHS England’s ambition to save £900m through introducing seven new care models may be optimistic – they are as yet unproven and their impact is still being evaluated.

The NAO this morning reiterated its call its 2014 report on the Better Care Fund for robust evidence on how best to improve care and save money through integration, and for a coordinated approach. NAO head Amyas Morse said: "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 STPs."

The independent health think tank Nuffield Trust pointed out that the NAO had found "no compelling evidence" to support the assumption that integrating hospital, community and social care services would save £4bn by reducing hospital activity. Its senior policy analyst Sally Gainsbury said: "This report should be taken as a stark warning that the government’s plans to squeeze billions from the NHS budget by shifting care into the community are built on sand ...

"As the NAO finds, the evidence to support the assumption that billions of pounds can be saved by moving patients into the community simply does not exist ... What’s more, even if it did prove cheaper to treat patients out of hospital, those savings could only be realised if the freed up wards or units were closed. With many hospitals currently running at over 95% capacity, the prospect of that happening looks remote."

She warned: "The report should serve as a wake-up call for government to rethink the assumption that continued funding constraints can be weathered without affecting quality of care and jeopardising the long-term sustainability of the health service."

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