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NHS to have protected slice of the joint health/social care fund

Better Care Fund will compensate hospitals if A&E admissions stall

Adrian O'Dowd

Monday, 07 July 2014

The government has changed the rules governing the joint Better Care Fund for health and social care to guarantee hospitals will not lose out and for some of the money to go to primary care.

The £3.8bn pooled budget designed for both the NHS and local councils to use from next year to fund initiatives to integrate health and social care has proved to be controversial.

Many concerns have been raised that the NHS could not afford to lose any money to local government particularly if  joint initiatives did not lead to a reduction in hospital admissions, as is planned.

Following a review of the first set of local plans for the Better Care Fund, the Department of Health and the Department for Communities and Local Government have announced a “renewed agreement”.

The new plans claim to strengthen a commitment to bring health and care service providers closer together to make joint decisions.

Plans to improve out of hospital care for older and vulnerable people will reduce emergency admissions, said the government.

The fund will now be used to compensate acute hospitals if any local integration initiatives do not lead to a reduction in emergency admissions.

Health secretary Jeremy Hunt promised last month that there would be an element of risk sharing in the fund, and the revised rules seem to confirm this.

Under the new rules, there will be more control over £1bn of the better care fund money and part of it will be kept back as performance-related payments, only given if local areas manage to cut A&E admissions by at least 3.5%.

In situations where A&E activity fails to reduce, the money kept back will be used to pay for it while the remainder of the £1bn not dependant on A&E activity will have to be spent within the NHS on non-acute services such as primary care.

The government is keen for the fund and joint schemes to begin from April of next year and to help this it will appoint a Better Care Fund programme director with an expanded team.

Mr Hunt said: “Local authorities and the NHS are making excellent progress in developing plans that will give patients better, joined up care and allow hospitals to focus on treating the people who really need to be there. The plans are packed full of ideas and show that strong partnerships are being forged with different teams like never before.

“Successive governments have talked about bringing the NHS and social care together for decades – this is the first, transformative step to making that a reality.”

Dr Maureen Baker, RCGP chair said: “Today's announcement sounds extremely promising, and has the potential to lead to real improvements in the standards of care that GPs can offer their patients.

“This boost to general practice is desperately needed. Over the last decade, investment in general practice has been cut back so much that, as patient demand has soared, the service has been left teetering on the brink of collapse.

“If general practice is allowed to collapse the effects would engulf the rest of the NHS like a tidal wave, with even more pressure being heaped on our already stretched hospitals.”

Responding to the revisions to the fund, Dr Judith Smith of think tank the Nuffield Trust said: “It’s good to see that the government has listened to the concerns we and others raised about the impact the fund could have on hospital finances in 2015-16, which is looking to be a crunch year for the NHS.”

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