The Better Care Fund is now part of the problem. We need a better solution

The Local Government Association’s decision to withdraw its support for the better care fund planning guidance marks a low point in the relationship between local government and the NHS, contrasting starkly with a generally positive commitment to work together.

The mood has changed and as summer draws to a close, this is a good time to take stock.

The NHS was forged in heat of a political battle in the 1940s between Nye Bevan and Herbert Morrison about who should run the new service. Local government lost, in part because of worries about what we would today call the postcode lottery. Nearly 70 years on, there has been no shortage of rhetoric about working together, punctuated by occasional bust-ups of one kind or another. How and where local health services are run involve choices that are inherently political, but the relationship has always survived and moved on. In that sense there is nothing new about the latest spat, but there are deeper undercurrents.

Far more promising is the emergence of accountable care systems, where existing organisations work together to use the public pound to get the best outcomes possible for local people.

Demand for healthcare continues to rise fast; hospital admissions are up nearly 4 per cent a year over the last 15 years and real-terms funding is barely increasing. Waiting times are rising and key performance targets are being routinely missed all year round. Tough action to reduce costs is prompting fresh concerns about rationing and the quality of care.

More from Richard Humphries on LGCplus (paywall)

In this context, a 50 per cent increase in delayed hospital discharges related to social care creates a huge problem for the NHS. No wonder that national talks about how the ”new” £2bn for social care should be used got fractious. That Simon Stevens described the existing BCF arrangements as “too laissez-faire” speaks volumes about profound differences in style and culture. Clearly it is not all about hospitals. Faced with multiple and competing demands on the new money, never has so much been expected by so many, of so little, so soon.

Thinking beyond the short term

There are no immediate or obvious solutions from the centre to the woes that beset the NHS and local government, in a national and international political climate that is fragile and uncertain. But there is plenty of scope for thinking beyond the short term about local approaches. The BCF was never more than a temporary sticking plaster and is now part of the problem.

Far more promising is the emergence of accountable care systems, where existing organisations work together to use the public pound to get the best outcomes possible for local people.

This plays directly to local government’s traditional concern with place, but can we learn from the lessons of sustainability and transformation partnerships and engage local government from the beginning? New thinking is needed about how to overcome historical governance and funding fault lines in developing new local approaches. There is no time to waste. Winter is coming.