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BCF not the be all and end all to integration

Source: PSE Apr/May 17

Grainne Siggins, national policy lead and trustee at the Association of Directors of Adult Social Care (ADASS), talks to PSE about the National Audit Office’s (NAO’s) recent report on health and social care integration.

In February, the NAO released its report into health and social care integration. In summary, it stated that the Better Care Fund (BCF) has not yet achieved the expected value for money, in terms of savings, outcomes for patients or hospital activity. 

Shortly after the launch of the bleak report, the chancellor, in his last Spring Budget, revealed plans for councils to receive £2bn of extra funding for social care over the next three years, which has received mixed responses. 

National policy lead and trustee at ADASS, Grainne Siggins, told PSE local authorities welcome the additional money within many areas. 

“But there is still some concern about the connectivity with the health service, and the parameters of that spend are being worked up as we speak. We don’t know what the final position is going to be, but it does need to help the whole of the social care system,” she said. 

“It [the extra funding] is a little bit of a sticking plaster, but the money cannot all be used for supporting hospital and out of hospital care.” 

Reflecting on the report, Siggins joked that many in the sector say that “even if we had a nuclear holocaust integration would continue to exist, because it is something that seems to have existed for years but we don’t seem to be able to fully achieve it on the ground with various initiatives”. 

She added that while the NAO focused on the BCF, the government’s narrative sometimes forgets what was happening on the ground before it came into being. 

Siggins noted that the Integration and Transformation Fund, which later became BCF, had seen some areas start to develop a level of planning where monies from health were then given to local government to facilitate local planning arrangements. 

“It signalled an environment where we were starting to work together and plan, with increased levels of integration, on the ground,” she said.  “My personal view, with regards to BCF, was that they didn’t engage the sector sufficiently in planning what successful integration will look like. 

“We had a whole range of national metrics and conditions to meet within BCF, and many areas did say that they could achieve some of them and they were building blocks for integration. For instance, a joint approach to assessment and care planning, section 75 signed off, open APIs for interoperability of systems. They were the building blocks to facilitate integration. 

“However, the NAO report does pull out quite well that there was a lack of an evidence base on what type of initiatives do work in order to support integrated care.” 

The director of adult social care at the London Borough of Newham added there has been a big push, through the use of multidisciplinary teams, to reduce the number of residents/patients attending acute hospitals – unless it is absolutely necessary. 

“All other care should, ideally, take place in the community,” she said. “But in order to try and achieve that, you need a step-up in the type of interventions that you are offering together in the community, and that is what the BCF enabled us to do. Where you had established relationships, and again this was picked up in the NAO report, often you were building on that. Some of the progress was more effective. 

“In areas where you didn’t necessarily have good relationships, it did encourage areas to communicate more effectively, establish effective leadership and governance, and establish joint programmes. I think that is where the issue about BCF and integration are aligned and together, but it isn’t the be all and end all; people were already working on integration before BCF.” 

The NAO had asked some industry representatives why progress hadn’t been achieved faster under BCF. But Siggins was candid in her answer to this: “We all know that establishing programmes, project management and briefs around projects, all take time. 

“The first year was about the building blocks for integration in many areas, which then continued and pilot initiatives were set up – they were not going to be fully embedded by the time they [NAO] did this review.”


The NAO’s ‘health and social care integration’ report can be accessed at:



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