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Reducing local A&E admissions linked to extra ‘Better Care’ funding

Up to £1bn of the Better Care Fund will be allocated to local areas to spend on out-of-hospital services according to the level of reduction in emergency admissions they achieve, the government has revealed. 

Changes to the government's £3.8bn fund following a review mean that up to £400m will be used to effectively ‘compensate’ acute hospital trusts if the local plans fail to cut admissions – a key concern of hospitals, who are seeing large amounts of funding shifted into the Better Care Fund. 

Richard Humphries, assistant director for policy at The King’s Fund health think tank, said: ‘This announcement is a sign of growing anxieties within government as the NHS heads towards a financial crunch in 2015/16. 

‘The changes announced may ease fears about financial meltdown among NHS providers but will add to the strain on local authorities – this in the week that the latest annual budget survey showed that pressures on social care budgets are resulting in more cuts to services.” 

The government says the renewed agreement has strengthened a commitment to bring health and care service providers closer together to make joint decisions, ensuring more people receive joined-up, personalised care closer to home. 

From April 2015, it is expected that the Better Care Fund will deliver more dignity and independence for the frail and elderly by providing the care they need at or closer to home; seven-day health and care services — to ensure that people can access the care they need when they need it; and joint assessments — so that services can work together to assess and meet people’s needs all in one go. 

It also means that as well as providing this kind of service to patients, Health and Wellbeing Boards – made up of councils and local health services – will be able to set their own performance pot with a guideline reduction in unplanned admissions of at least 3.5%. This equates to at least 185,500 fewer admissions a year. The balance of their current performance allocation will then be spent on NHS-commissioned community services. 

Following a review of 151 local area ‘Better Care’ plans, NHS England and the Local Government Association (LGA) found that more than 80% of local area plans are on course to transform ‘out of hospital’ services. NHS England and the LGA have also identified 14 areas that can fast track the completion of their plans because they are already showing high potential. These include: 

  • Dudley
  • Hammersmith and Fulham
  • Kensington and Chelsea
  • Westminster
  • Greenwich
  • Leeds
  • Liverpool
  • Nottinghamshire
  • Reading
  • Sunderland
  • Rotherham
  • Torbay
  • Warwickshire
  • Wiltshire 

The plans will be further reviewed by DCLG Permanent Secretary Sir Bob Kerslake and NHS England chief executive Simon Stevens later in the summer to ensure they are ambitious enough to achieve improvements in care and that every area is on track to begin in April next year. In order to drive this through at pace a new Better Care Fund programme director will also be appointed with an expanded team, working across Whitehall, local government and the NHS. 

Health secretary Jeremy Hunt said: “Local authorities and the NHS are making excellent progress in developing plans that will give patients better, joined up care and allow hospitals to focus on treating the people who really need to be there. The plans are packed full of ideas and show that strong partnerships are being forged with different teams like never before.” 

The Foundation Trust Network welcomed the changes, but chief executive Chris Hopson added: “Significant risk still remains. Local areas are being asked to plan for a 3.5% reduction in emergency admissions in 2015-16 when last winter, the mildest in a century, admissions rose by 4 per cent and trusts are reporting similar, if not greater, increases for the first quarter of 2014-15. 

“We have less than 300 days to put the new patterns of care in place to deliver these reductions. Whilst some plans have been produced in collaboration with providers, many of our members also tell us that they are still not fully involved in this planning process and the Health and Wellbeing Boards that oversee it. There is clearly also a significant risk to social care here, with knock on consequences for health. The 2015/16 Public Expenditure settlement took £1.9 billion out of total health and social care/local authority spending and the impact of that has to fall somewhere”. 

The DH and DCLG added that revised guidance for local areas to shape the further development of local Better Care Fund plans will be set out shortly. This will include information on the revised performance payment scheme, as well as specific areas where local plans need to be strengthened through providing further detail on local plans. 

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