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Better Care Fund ‘built on flawed logic’

Nuffield Trust says Government is right to review Fund

Louise Prime

Wednesday, 07 May 2014

The Government is right to review the Better Care Fund, which “is built on flawed logic”, the Nuffield Trust said this morning in response to a report in The Guardian that the plan is being delayed.

The Guardian said a confidential Whitehall review had concluded that the Better Care Fund would not work to reduce pressure on hospitals as anticipated – neither helping to balance the NHS budget, nor revolutionising patient care. It reported that the Cabinet Office has called for “a lot more work to be done on the policy” because of concerns that claims made for the plan did not stack up.

The Nuffield Trust’s chief executive Nigel Edwards said: “While nobody can argue with the very sound principle of bringing health and social care closer together, the Better Care Fund is built on flawed logic and the Government is right to review it.

“The Fund assumes that hospitals can quickly achieve a 15% reduction in emergency admissions and that these reductions will result in savings in the same year, at full cost. But reducing admissions takes time, and lowering the types of admissions targeted by the Better Care Fund costs money. These assumptions are therefore wildly optimistic.”

He warned that poorly planned large-scale budgetary changes could have dire consequences. He said: “The wishful thinking underpinning the Better Care Fund is more than just an inconvenience. With almost half of all acute hospitals already in deficit, there is a very real danger that shifting £1.9bn largely out of the hospital budget, as this policy proposes, could lead to a widespread financial collapse across the acute hospital sector.”

The Nuffield Trust pointed out that during its evaluations of more than 30 integrated care programmes – many of which had reducing urgent hospital admissions as a key goal – it had “found little evidence of cost-effective reductions in hospital admissions from such initiatives”. It said this resulted partly from commissioners being impatient for change in too short a timescale, and partly from the initiatives themselves often not being well designed to fit in with other services.

Nigel Edwards went on: “The Cabinet Office is right to be asking searching questions about these plans. Simply expecting efficiencies from hospitals to deliver the savings needed for the Fund on top of already very challenging targets is not going to work. Delaying its implementation and focusing on how to get patients home from hospital more quickly should be a priority.

“A credible approach needs to contain the growth both in hospital admissions and the time patients stay in hospital, which, due to the ageing and growing population could result in a requirement for a further 15,000 hospital beds in the next seven years.”

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