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NHS better care fund 'a shambles', says MP in wake of audit

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A scheme to slash £1bn from NHS costs by reducing unnecessary hospital visits for OAPs has been branded a “shambles” after a spending watchdog said it was unlikely even to achieve even a third of that saving.

The National Audit Office said a fundamental failure to plan properly in Whitehall had seriously undermined the otherwise “innovative” Better Care Fund leaving local bodies facing a race against time to implement their shake-ups.

“Such incompetence from departments is unacceptable at a time when the number of people most likely to need care is rising, and overall funding is falling”

Margaret Hodge

And it warned that an aim of reducing emergency admissions by at least 3.5% by better coordinating health and care provision would be a “struggle” when they had risen 47% over the past 15 years. Officials now face a grilling by MPs over what the chair of the Commons public accounts committee called “unacceptable incompetence”.

Health secretary Jeremy Hunt says the project will allow hospitals to “focus on treating the patients who really need to be there”, cutting delayed discharges by 101,000 a year, stays in accident and emergency by 163,000 and allowing 2,000 more elderly people to stay in their own homes.

Jeremy Hunt

Jeremy Hunt

But the hoped-for savings have been massively downgraded since the outset and the NAO cautioned that the revised benefits “may still be overoptimistic” and are “bold assumptions … based on optimism rather than evidence”.

Initial plans submitted by 151 local health and wellbeing boards in April 2014 were assessed as capable of delivering only £55m of savings, the NAO report said, pointing the finger at the way the process was run.

It said there was “no central programme team, no programme director and limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support”.

“In addition, the initial scheme guidance did not mention the scale of savings expected from the fund.”

After imposing a pause to beef up the scope of the fund, a fresh round of proposals – involving the pooling of £5.3bn of existing resources – were put forward in September and declared by NHS chiefs to be capable of reducing costs by £532m, of which £314m would come off NHS costs.

That lengthy delay sparked further concerns for the NAO, which pointed out that the time available for local bodies to make the necessary preparations for the April 2015 start - such as training staff - had been more than halved from 11 months to five.

It also noted that the changes were opposed by the Local Government Association which believed that they “undermine the Fund’s core purpose as promoting locally led integrated care and reduce the resources available to protect social care and prevention initiatives”.

The NAO suggested there was “limited evidence that integrated care is effective in reducing emergency admissions sustainably, improving outcomes for patients and saving money”.

Public accounts committee chair Margaret Hodge said she was “dismayed that planning for the Better Care Fund has been such a shambles”.

Margaret Hodge MP

Margaret Hodge MP

“Successful delivery depends on goodwill and joint commitment but delays and changes to the Fund’s design have weakened its credibility with local bodies and lost goodwill,”she said.

“It is deeply disturbing that local government believes the changes to targets and how the fund will be run move the integration agenda backward and not forward,” said Ms Hodge.

“Furthermore, the assumption that local areas can achieve a reduction in emergency admissions of 3.1% is a triumph of hope over reality,” she added.

“The Better Care Fund is a complex and challenging initiative that clearly requires strong leadership and effective cross-government working, both of which have been lacking. It is hard to believe that until recently there was no central management team or programme director and there were only limited attempts to identify and manage risks to successful delivery.

“Such incompetence from departments is unacceptable at a time when the number of people most likely to need care is rising, and overall funding is falling,” she said. “We will robustly question officials on plans for the Fund when they appear before us in December.”

National Audit Office

Amyas Morse

NAO head Amyas Morse said: “The Better Care Fund is an innovative idea but the quality of early preparation and planning did not match the scale of the ambition.

“The £1 billion financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government’s confidence in the Fund’s value.”

The government has rejected the criticisms.




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