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NAO: Care fund failures put integration 'at risk'

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The failure of the Better Care Fund to deliver savings, improved patient outcomes and reductions in emergency admissions has put the government’s plan for health and social care integration by 2020 at “significant risk”, the National Audit Office has found.

A report published today said the integration of services have been hindered by rising demand for care at a time of financial pressures on both the NHS and local government.

The NAO also said that despite the government identifying barriers to integration, such as “misaligned” financial incentives across the health and social care system, workforce challenges and resistance to information sharing, departments had failed to systematically address these issues.

The report found the £5.3bn spent through BCF in 2015-16 did not achieve its principal targets in the first year.

Despite a planned reduction in emergency admissions of 106,000, the numbers rose by 87,000, resulting in costs of £311m more than planned.

In 2015-16, delayed transfers of care increased by 185,000 on the previous year, compared to a planned fall of 293,000.

This cost £146m more than expected, the report said.

The NAO said integration could take “many years” because of “very different” cultures in health and local government, with the best performing areas having worked on coordinated care for up to 20 years.

The NAO said it had found “no compelling evidence” that integration would lead to sustainable savings and reduced hospital activity, with evaluations inhibited by limitations on comparable cost data across different care settings.

The government is planning to simplify the BCF assurance arrangements, with the number of conditions areas are required to meet set to reduce from eight to three.

BCF itself will be boosted by £2.4bn in the last two years of this parliament.

But the report said the Department of Health had not clarified how the BCF aligns with the new sustainability and transformation planning process.

The report said of the £2.1bn NHS sustainability and transformation fund for 2016-17, £1.8 billion was allocated to cover NHS deficits.

It adds that without full local authority engagement STP process, there is a risk that integration would “become sidelined in the pursuit of NHS financial sustainability”.

However, the report said BCF had incentivised organisations to work together.

It had reduced permanent admissions of people over 65 to residential and nursing care homes and increased the proportion of older people receiving reablement or rehabilitation services after being discharged from hospital.

Margaret Willcox, president elect of the Association of Directors of Adult Social Services, said the case for a “single, shared and sustainable funding settlement” for health and social care was “overwhelming”.

She added: “Integration is not the answer to improving social care, but should be seen as the means to an end to transform services to provide better coordinated care for people who need it.

“The risk of integration is that it focuses on structure whereas the focus should be on the potential to improve outcomes.”

Head of the NAO Amyas Morse said: “Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure.

“So far, benefits have fallen far short of plans, despite much effort. It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans.”

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