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Better Care Fund will deliver less than a third of planned savings – NAO

The Better Care Fund will not deliver even a third of the planned £1bn savings as early preparations were “inadequate” and “did not match the scale of the ambition”, a new report from the National Audit Office has found, leading MPs to brandish the scheme a “shambles”.

The £5.3bn Fund, drawn from existing NHS and council budgets, has been designed to integrate health and social care in an effort to reduce A&E admissions, treat people in the community and cut the length of stay in hospitals for old and disabled people. It will see the funding split among 151 localities to be used on locally-led schemes and is due to be introduced in April 2015. However, initial plans did not meet ministers’ expectations or offer the level of savings expected. As a result, local teams resubmitted the plans to government in April this year.

Initial plans estimated that the Better Care Fund would save the NHS £1bn in 2015-16, but revised estimates put that figure at only £314m of savings.

It was agreed that local areas would develop plans for spending the Fund with minimal central prescription, in an attempt to drive local innovation. However this has resulted in “no central programme team, no programme director and limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support”, the NAO has concluded.

The NAO is also sceptical of local areas’ abilities to meet the prescribed target of a 3.5% reduction in emergency admissions. According to the report this would be a “struggle” when admissions have risen 47% over the past 15 years.

In addition, the initial scheme guidance failed to mention the scale of savings expected from the fund.

Amyas Morse, head of the NAO, said that ministers were right to pause and redesign the scheme when they realised it would not meet expectations.

“The Better Care Fund is an innovative idea but the quality of early preparation and planning did not match the scale of the ambition. The £1bn financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government's confidence in the Fund's value.”

He added: “The Fund still contains bold assumptions about the financial savings expected in 2015-16 from reductions in emergency admissions. To offer value for money, the Departments need to ensure more effective support to local areas, better joint working between health bodies and local government, and improved evidence on effectiveness.”

Margaret Hodge, chair of the Commons Public Accounts Committee, has branded the planning for the scheme a “shambles”.

She added: “Successful delivery depends on goodwill and joint commitment but delays and changes to the Fund’s design have weakened its credibility with local bodies and lost goodwill. It is deeply disturbing that local government believes the changes to targets and how the Fund will be run move the integration agenda backward and not forward.”

Cllr Izzi Seccombe, chair of the LGA's Community Wellbeing Board, believes the report does not recognise local contributions and that it is too soon to draw conclusions about the Fund.

"This report fails to recognise the significant work that councils and local health organisations have had to undertake to make sure that vulnerable people do not suffer at the hands of last minute government changes to the Better Care Fund,” she said.

"It also fails to recognise that a local approach is the only way to bring together health and social care and not a top-down approach from Whitehall. The micro-management of this process has seen no significant changes in the plans themselves or in the care and support they can be expected to bring to people who need it most. It is obviously too soon to conclude about the success of the Better Care Fund at this stage.

"The failure to set out the £1bn savings target to councils along with Ministers' decisions to move the goal posts to respond to financial concerns raised by the NHS, has made carrying out these plans more difficult and left many councils with significantly less time to implement the changes before the April 2015 deadline.”

The Department of Health said it disagreed with the criticism of the early stages of the programme.

A spokesperson said: “This is the most ambitious plan to transform care ever undertaken and we ensured detailed work took place a year ahead of the launch to allow us time to iron out the issues that the NAO itself now acknowledges have been addressed.

“Last month over 97% of local areas had their plans approved, ensuring that people will be able to get seven-day care services that work for them and saving an estimated half a billion pounds of taxpayers' money too.”

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