MPs criticise Stevens over better care fund 'accountability'

In a report published today, the Commons public accounts committee also said the better care fund had failed to achieve its objectives and is “little more than a complicated ruse” to “paper over” adult social care funding pressures.

It said the BCF had not saved money, or reduced emergency admissions to hospitals and delayed transfers of care.

The committee also said witnesses who gave evidence to its inquiry had “displayed an appallingly casual attitude to the targets that had been set”.

It specifically criticised the NHS England chief executive. Its report said: “It is deeply unsatisfactory that the departments and NHS England washed their hands of any accountability for the Better Care Fund. NHS England’s chief executive seemed to reject any accountability for the performance of the fund over its first year.

“He dissociated himself from the targets set for its first year, saying that it had not been designed by any of the witnesses at our evidence session. No other witnesses demurred from this assertion. The committee is very disappointed by this response; as we reported in February 2015, the arrival of NHS England’s new chief executive in April 2014 was the stimulus for the pause and redesign of the fund. Accounting officers cannot disown the plans of their predecessors.”

The committee called on the NHS to find better ways to engage “more genuinely” with councils and local populations in order to progress sustainability and transformation plans (STP), with place-based planning “critical” to the future of health and social care.

The inquiry heard that the BCF had plugged gaps caused by reducing social care budgets and had created significant and “disproportionate” bureaucracy that had in some cases disrupted integration.

The report said the BCF had now been left “largely redundant” by the STP process and called on the government and NHS England to reassess whether it was still necessary in its current form.

It also said successful approaches to integration under the BCF should be identified and applied to STP planning.

However, the committee said it was “unconvinced” that STPs would succeed where the BCF had failed, with “credible, robust and rigorous” plans developed in “very few areas”.

The 2017-19 Integration and Better Care Fund Policy Framework was published by the Department of Health, and Department for Communities & Local Government last month.

It included guidelines on how the extra £2bn for social care announced in the budget could be spent.

The areas outlined were reducing pressures on the NHS, including delayed transfers of care and supporting the local social care provider market, as well as  helping to cover the cost of implementing the national living wage.

The conditions attached to the additional funding, which the framework describes as a social care grant, were due to be confirmed in this month - but they have not yet been published.

Responding to the PAC report, an NHS England spokeswoman said: ”It seems odd for a report to simultaneously claim that the original BCF was a ‘complicated ruse’, but then go on to criticise public servants for being frank about its operation. When called to give evidence before Parliament we make no apologies for responding to questions honestly and openly.”