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Senior NHS leader urges caution on predicting big savings from Better Care Fund

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6595 (Published 03 November 2014) Cite this as: BMJ 2014;349:g6595
  1. Gareth Iacobucci
  1. 1The BMJ

The NHS in England and local councils have committed an additional £1.5bn (€1.9bn; $2.4bn) funding in pooled budgets to the government’s Better Care Fund to boost efforts to provide integrated health and social care in the community. The fund, due to launch in April 2015, will be increased from £3.8bn to £5.3 billion as a result of the increased investment.

The health secretary, Jeremy Hunt, said that the move would improve care and potentially save more than £500m through reductions in emergency admissions and other measures. But a senior NHS leader warned that the evidence that the plan could deliver financial savings at such a scale was inconclusive.

In a speech to the National Children and Adult Services Conference 2014 on 30 October,1 Hunt told delegates that 97% of the 151 joint plans developed by local councils and the NHS through the fund had been approved. He said these had the potential to achieve 163 000 fewer stays in hospital emergency departments, resulting in a 3% reduction in admissions and savings of £253m.

Local estimates indicated that the fund would help at least 18 000 health and care professionals—including social workers, occupational therapists, doctors, and nurses—to take up new roles delivering care in the community, he added. The plan could also result in £532m saved for health and care services, 101 000 fewer unnecessary days spent in hospital by reducing delays in the transfer of care, 12 000 more older people still at home three months after being discharged from hospital, and 2000 more people spared from being admitted into a care home and supported to live independently, Hunt said.

The health secretary said that the plans were supported by the Local Government Association and were a key part of the government’s response to the call for further integration of health and social care, as set out in NHS England’s Five Year Forward View.2

Hunt said, “For years, successive governments and NHS leaders have talked about joining up our health and care services so people get better care at the right time and in the right place. The time for talk is over: our plans will make this vision a reality for patients and help deliver a sustainable future for the NHS.”

The announcement came after the initial plan to top slice £1.9bn from NHS commissioning budgets and transfer the money directly to local authorities was modified so that at least £1bn of that funding would remain with the NHS.3 This followed warnings that the NHS would need to see the equivalent of a 15% cut in emergency admissions to plug such a deficit.

Johnny Marshall, director of policy at the NHS Confederation and senior adviser to the NHS Clinical Commissioners representative group, said that the fund had acted as “an important catalyst” to driving change but added that it still held risks to the NHS. “In particular, we reiterate our concerns about the ability of some local areas to achieve the reductions in levels of emergency activity and financial savings that the Better Fund requires,” he said.

“Politicians also need to recognise that while there is much evidence that greater integration and personalisation improves outcomes, the evidence that it delivers financial savings is still in its early stages.”

Health secretary Jeremy Hunt

Joe Giddens/PA

Notes

Cite this as: BMJ 2014;349:g6595

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