Better Care Fund
The £3.8bn Better Care Fund was announced in June 2013. Its aim is to transform health and social care integration at a local level, in order to improve outcomes for local people, through the pooling of existing health and social care funding between CCGs and local authorities.
The £3.8bn Better Care Fund was allocated to local commissioners for 2015/16 on condition that:
- CCGs and local authorities jointly agreed plans for how the money would be spent;
- The spending plan was approved by NHS England; and
- The funds would be paid by the CCGs (once received as part of their allocations) into a pooled fund set up under section 75 of the NHS Act 2006 ("Section 75").
Local health and wellbeing boards oversee the strategic direction of the Better Care Fund and the delivery of better integrated care as part of their statutory duty to encourage integrated working between commissioners.
CCGs and local authority spending plans had to meet the requirements of planning guidance issued by NHS England, including by setting out:
- Performance objectives, i.e. the local target for reducing non-elective admissions and how those objectives would be achieved; and
- How local social care services would be protected within the plans and the impact of the plans on local providers.
The local Health and Wellbeing Board would sign off the Better Care Fund plan for its constituent local authorities and CCG.
Arrangements for operational oversight of the Better Care Fund plans in each area are set out in agreements between the CCGs and local authorities under Section 75. Regulations made under Section 75 require those agreements to set out (amongst other things):
- Arrangements for monitoring the delivery of the services that it covers;
- Who the "host" organisation is that will be responsible for accounting and audit in relation to the pooled fund; and
- Who the "pool manager" is that will be responsible for submitting to the CCG and local authority monitoring reports on income and expenditure from the pooled fund and other monitoring information.
A partnership board with membership from both CCGs and local authorities was in place in each area to govern the arrangements.
Overcoming the challenges
Key challenges for commissioners in implementing the Better Care Fund plans include:
- Relationships between commissioners not being sufficiently developed to make full use of the flexibilities available to enable integration under Section 75. For example, many commissioners have simply pooled funds as required, without fully integrating commissioning of health and social care services by using the joint commissioning flexibility;
- A lack of time to fully develop effective spending plans to get the most out of the Better Care Fund monies and Section 75 flexibilities exacerbated by a lack of timely central support to do so
- Putting in place governance arrangements to oversee the delivery of Better Care Fund plans both on operational and strategic levels. The (necessary) involvement of Health and Wellbeing Boards initially confused governance arrangements with some suggesting that Health and Wellbeing Boards could be the partnership boards envisaged under Section 75, whereas this was not actually appropriate in legal or governance terms;
- Linked to the governance arrangements, the role of providers on some Health and Wellbeing Boards has to be carefully managed given the potential for conflicts of interest where, for example, the impact of Better Care Fund plans should be to reduce non-elective admissions to local acute hospital providers; and
- There has been some criticism that the Better Care Fund has allowed NHS funding to 'prop up' social care services, and fill in the holes in social care funding, rather than promote true collaboration between commissioners to integrate health and social care services. The evaluation of the first year of Better Care Fund operation will be critical to inform next steps with this initiative.