Alarm bells were ringing when the fund proposals were familiar, conservative and far from transformational, says the chair of the Carers Trust
It was an unfortunate coincidence that the latest state-of-the-art aircraft carrier (for which there are no planes) was named in the same week that plans to modify the £3.8bn better care fund were confirmed.
There must be legitimate concerns about when either will fulfil the purpose for which it was designed.
The better care fund concept was always the servant of two masters. Its political purpose was to support integration, prevent unnecessary admissions and accelerate the shift of activity from hospitals to home.
For local government it was mitigation for the substantial cuts the sector faced in successive spending reviews in order to offer some protection for adult social care.
The fund was never new money. It packaged previous funding assumptions, augmented by a top-slice from existing clinical commissioning group budgets, to be jointly deployed against the objectives of the fund.
History tells us that success in developing new patterns of service between health and social care has usually required additional seed funding, such as joint finance programmes in the 1980s, to establish proof of concept alongside the changes needed. It is also important to have a shared purpose and complementary incentives built into the exercise. Many of us thought these would be clarified by the pioneer sites that preceded the announcement of the fund.
We also need to clarify the question to which closer integration is the answer. What wicked issue is best addressed this way and what is the business case that supports it?
I suspect the major issue was to kickstart definitively the process of pooling resources across health and social care. But three linked issues also needed addressing: managing demand on the acute sector by growing activity outside hospital; sustaining social care; and reducing overall expenditure across the sector.
Alarm bells were already ringing when the detailed proposals were submitted by councils and CCGs. The range of interventions identified were generally very familiar, conservative and far from transformational. Most NHS acute trusts said they had not been involved sufficiently and that the planned disinvestment threatened their viability. The Treasury is also reported as getting cold feet.
The modifications still perpetuate the idea that the fund is an entity rather than an earmarking of CCG resources. But its allocation is now firmly to meet NHS objectives to reduce emergency admissions and it is performance related.
The balance will be used to support NHS-commissioned local services. While previous commitments to social care are kept, it is unlikely that any of the earmarked resources will now reach this sector.
The fund might have worked, but there will be no take-offs for social care from this carrier.
Andrew Cozens, chair, Carers Trust