The Better Care Fund: a disaster in waiting?BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3345 (Published 16 May 2014) Cite this as: BMJ 2014;348:g3345
- Nigel Hawkes, freelance journalist, London
Some projects in the NHS in England start well and then go sour—think of Connecting for Health. Others, despite being makeshift, at least put a poultice on a painful boil—the Cancer Drugs Fund, for example. And then there are those that sound good on paper, tick enough of the right boxes to face no intellectual challenge, but nevertheless look like a disaster in waiting from their very inception. Here is where we find the Better Care Fund.
The idea is to take some money from acute care trusts and give it to local authorities to be spent in providing better health and social services in the community, thereby preventing so many admissions that hospitals won’t even notice the loss of income. It seeks a virtuous circle of fewer admissions and faster discharges, easing pressure on the acute sector while providing care in the places patients are supposed to want it—a worthwhile aspiration.
But there is confusion at almost every level. The transfers involved, totalling £3.8bn (€4.7bn; $6.4bn), are large enough to destabilise many acute trusts but too small to replenish the losses local authorities have suffered in the years of retrenchment since 2010. …