Better Care Fund creates uncertainty for adult social care

Margaret Hodge, chairman of the Public Accounts Committee

It is not certain that all local authorities will be able to protect adult social care under new arrangements for funding, according to a report by the Public Accounts Committee.

The report published today (Thursday) reveals that at the time of committee hearings in December, 14 local plans presented serious concerns relating to the protection of such services.

It said the government should publish an annual scorecard to demonstrate how the fund is supporting integration, maintaining adult social care, reducing emergency admissions and saving money.

The report said: “Demographic changes mean demand for adult social care services is increasing at a time when available resources are shrinking, and the scale of the challenge facing local government and the NHS is growing as demand for health and care services increases.

“All the agencies involved need to rise to this challenge as failure, particularly for older and disabled people, is not an option.”

The Better Care fund is aimed at delivering joined-up services by pooling £5.3bn of NHS and local authority funding to save £532m in the first year of the scheme in 2015-16.

However, the fund was redesigned in April 2014, requiring health and wellbeing boards run by local authorities to resubmit their original plans.

Committee chairman Margaret Hodge said the process had resulted in “wasted time, effort and money”.

In addition, the revised plans were required collectively to protect £1bn of NHS resources, which had not originally been factored in by the boards.

Hodge said: “It appears to the committee that NHS spending was judged a higher priority than supporting adult social care.”

The Local Government Association told the committee that the redesigned scheme had moved the integration agenda backwards and that local government had contemplated walking away from the fund.

The committee also raised concerns over accountability for monitoring spending and outcomes under the fund.

It said: “At a local level, health and wellbeing boards approved local plans for the Fund, but they could not implement plans without ministerial approval.

“It is not yet clear who is responsible for performance management of the Fund once it starts.”

Richard Harbord, former chief executive at Boston Borough Council, told Room151 that the Better Care Fund should be welcomed for forcing collaboration between the NHS and social care departments But added there has been a reluctance to set up structures to manage because plans only extend to 2015-16.

He added: “There is also a feeling that it is very rule driven and not sufficiently enabling.  In addition, there is, I think, a fear that extra money given to the NHS for new initiatives does end up filling emergency gaps the whole time.”

Speaking to Room151, Andrew Burns, director of finance and resources at Staffordshire County Council and president of the Society of County Treasurers (SCT), admitted that there was “more work to do” on lines of accountability for the fund in some areas of the country.

However, he added that the redesigned scheme had led to more money becoming available under the fund, and that the intentions behind it are sensible.

He said: “The Better Care Fund, and a range of machinery including health and welfare boards are a good thing.

“Getting councils and clinical commission groups to sign up to the plans has not been easy but we have all come to the view that we have to think about these funds in a different way for both our benefits.”

Photo (cropped): ICAS, Flickr