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Better care fund intransigence must be overcome

Nick Golding
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LGC’s acting editor on why the resources must be found to invest in social care

Andrew Ridley faces a difficult job. As the better care fund’s programme director, Mr Ridley has to nurture it from a promising idea to a fully functioning reality. However, he must do this at a time when the vultures of vested interest are circling above, desperate to eliminate any threat to their resources.

The fund was envisaged as a way of using NHS cash to invest upfront in social care in a sensible attempt to reduce demand for acute services later on. However, panic has ensued as it became apparent that expenditure in long-term projects to reduce demand – and to care for people more comfortably in their homes rather than in acute settings – would leave less money, in the short term at least, for hospitals.

Councils have fairly pointed out that far-sighted investments do not always pay immediate dividends, although this argument hasn’t won the day in the corridors of power: NHS England has previously indicated it expects better care fund plans to save £1bn in 2015-16.

The difficulties besetting the better care fund show how hard it is to make even the slightest progress

Hospitals are rightly concerned about the knock-on effects to their resources. However, they have experienced nothing like the hardship that councils have endured and too often they have been unwilling to concede that investment in the lower levels of the care system can reduce the need for care in acute settings and costs overall.

A compromise was reached last month in which hospitals were promised compensation if the better care fund did not immediately result in reduced emergency admissions. One fears they will regularly receive this, leaving less resource for demand management.

More sensibly, acute providers were given the chance to comment on local better care fund plans. However, one hopes NHS England will be prepared to override any unjustifiable opposition to the culture of joint work that the care fund is supposed to bring about, although in the sensitive run-up to a general election, anything that threatens a hospital’s resources can be political dynamite.

Mr Ridley has this week used an LGC interview to insist health and wellbeing boards are still trusted to draw up plans and the programme is on course. We must hope he is correct and that every area will see a better care fund plan implemented by April next year.

Andrea Sutcliffe is another person with a difficult job – and it is a job that will get even harder if the better care fund does not work. As the chief inspector of adult social care, she is someone who deals with problems, many of which stem from the historic underfunding of social care.

Ms Sutcliffe also spoke to LGC, revealing how the Care Quality Commission should be prepared to say if it thinks an area’s social care services are underfunded. This is a welcome development. However, it is unclear who should do what if the chief inspector exercises this power – councils often simply don’t have the money to invest in the sector after their funding cuts.

The seriousness of the social care funding crisis cannot be overstated. The difficulties besetting the better care fund show how hard it is to make even the slightest progress.

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