National Audit Office's 'Health and social care integration' report

In February 2017, the National Audit Office (NAO) published the 'Health and social care integration' report. The report examined progress made by the Department of Health, the Department for Communities and Local Government and NHS England on integrating health and social care services, including a focus on the first year of implementation of the Better Care Fund.

On the report's publication, head of the NAO Sir Amyas Morse said:

'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.'

Implementation of the Better Care Fund

The Better Care Fund was announced in the 2013 Spending Review and established through the Care Act 2014. The Fund shifted resources from the NHS to social care. It required local health bodies and local authorities to pool existing funding and produce joint plans for integrating services and reducing pressure on hospitals.

The NAO's report found that the Fund had increased joint working and the provision of integrated services. However, in the face of increased demand for care and constrained finances, it had 'not yet achieved its potential to manage demand for healthcare; support out-of-hospital care; improve outcomes for patients; or save money'. Transferring funding from the health sector to social care without adverse impact on the NHS had proved difficult as the health sector was under financial pressure. As a result, the BCF had not achieved 'the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity, from the £5.3 billion spent through the Fund in 2015-16'.

The report also stated that government departments, NHS England and the Local Government Association held different expectations about the BCF. NHS England and the Department of Health had worked on the assumption that the BCF would save the NHS £1bn. However, the savings expectation was not agreed with the Department for Communities and Local Government, who therefore did not plan on the basis of this target.

Response and later developments

The Local Government Association responded positively to the report. Their response highlighted that 'the lack of funding for care and support is making it increasingly difficult for local authorities to plan effectively to bring together health and social care around the person.'

A month after the NAO's report, the Department of Health published the 'Integration and Better Care Fund, Policy Framework 2017–2019' with plans to support the objective of integrated care by 2020.