Has the Better Care Fund worked ?

Well intentioned but needs equality in social care funding as well as a ‘bureaucratic enema”

Yes :

  • A catalyst for a national and local conversation around integrated services from health and social care.
  • The requirement that plans are signed off by health and wellbeing boards has created a shared understanding of the challenges of delivering integrated services
  • The size of the fund was meaningful: it represented just 3 per cent of the NHS budget but around 20 per cent of the social care budget.
  • The opportunity to share best practice and learning has helped some areas move forward. There was a start to local problems being jointly owned.
  • It led to a picture of how commissioning intentions impacted on the whole system and included providers in the conversation.

No :

  • The heavy bureaucracy and mixed messages from the Department for Communities and Local Government, the Department of Health and NHS England belied the goal of more integrated working between health and social care.
  • The judgment of the better care fund is by some about finance, when those and other benefits will not have been realisable at this point,
  • The national process to date has arguably been frequently perceived to be about creating a plan and filling in the forms correctly, not necessarily delivery.
  • There are many in local government who see themselves as victims of a process, when they were intended to be beneficiaries.
  • The requirements of the process were too generic to be sufficiently flexible to the nuances in different localities.
  • The fundamental flaw in the analysis is the belief that a single policy around funding can fix the problem, or that it is synonymous with integrated care.

The better care fund will never succeed fully unless it is part of another group of parallel changes that promote more integrated care.

What is required is:

  • a multidirectional approach from provider development, education and training;
  • removing biases in the system;
  • information sharing;
  • maximising the involvement of – and sharing care with – individuals.

Financial flow and tariff changes are important as well. But start with better care for the citizen, then align the rest to make that happen.

Ref: The better care fund needs to be stripped of bureaucracy : HSJ – 9 December 2014