Better Care Fund announcement and early planning

In the June 2013 spending round, Chancellor George Osborne announced the Better Care Fund (BCF) – originally called the Integration Transformation Fund.

The government would transfer £3.8bn from health services into a single, pooled budget for health and social care services, starting from April 2015, with the stated intention that integrated care become 'the norm by 2018'.

Initially, it was planned that £1bn of the BCF would be linked to improvements achieved in outcomes for local people.

Clinical commissioning groups, local authorities and health and wellbeing boards would be required to work together to agree a joint area plan in order to access the BCF money. Commissioners were expected to work with providers to develop a shared vision of future service provision.

Within the plans, local areas were required to:

• explain how they would protect social care services
• show how they would enable 7-day social and health care services to prevent gaps in care and unnecessary admissions over weekends
• show how better data sharing between health and social care would be undertaken
• ensure a joint approach to assessments and care planning
• demonstrate agreement on the impact of changes on the local acute sector.

Early planning and revisions

In November 2014, the National Audit Office (NAO) published a report on progress with the BCF so far. The NAO concluded that it was an innovative and ambitious approach, but early planning and preparations had not been effective.

All 151 health and wellbeing boards submitted plans (amounting to £5.5bn) in April 2014. However, NHS England concluded that the plans submitted would not make the expected savings. Planning for the BCF then paused until July 2014 as the government revised the £1bn pay-for-performance element.

In July 2014, the departments changed the conditions attached to the performance-related element. Areas were asked to resubmit plans in September 2014 and were asked to aim for a 3.5% reduction in total emergency admissions compared to 2013.

Forecasts suggested that £532m (314m for the NHS) of savings could be made. However, the NAO noted that the time for local planning had been reduced, which would make it harder to meet the targets. Local government did not agree with the changes, stating publicly that they undermined the BCF's primary aim to promote locally led integrated care.

The NAO recommended that the Department of Health and the Department for Communities and Local Government needed to clarify the BCF's long-term vision and develop indicators to measure the success of local service changes and integration.