Four of the first five better care fund plans to receive official approval are all aiming for less than the ‘expected minimum target’ of a 3.5 per cent reduction in emergency admissions.

Despite this, some hospital providers remain sceptical that the approved schemes will achieve the falls in non-elective activity their commissioners are predicting, the published plans reveal.

Better care fund plans from Greenwich, Nottinghamshire, Reading, Sunderland and Wiltshire this week became the first to be signed off under the strengthened assurance process unveiled this summer by NHS England, the Department of Health and the Local Government Association.

Health and wellbeing boards across the country have been revising their better care fund proposals since central authorities asked for more robust finance and operational plans last spring. Final submissions are due on 19 September, with final sign off scheduled for 10 October.

Guidance issued in July by the government, NHS England and the LGA states that the “expected minimum target” for better care fund plans is a 3.5 per cent reduction in non-elective admissions in 2015-16, unless the HWB can make a “credible case” for a lower target.

Sunderland’s target is 0.8 per cent. It argues that non-elective activity fell in 2013-14, and is continuing to drop this year, and promises a more substantial reduction of 15 per cent from 2016-17 onwards.

Meanwhile Reading is planning for a cut of 2.8 per cent in 2015-16. It acknowledges that this is below the central target, but says it is nevertheless “very ambitious”, as Reading already has low levels of emergency admissions.

Wiltshire is aiming for a 3.75 per cent cut, but only once a projected 2 per cent rise in admissions is factored in, meaning the actual planned cut is 1.75 per cent.

Sections of the approved plans filled out by providers show the acute sector is not convinced that emergency activity will reduce by as much as commissioners hope.

Sunderland’s providers believe the fund will achieve only half of its projected activity reductions, based on projections of increasing demand from older patients and “historical delivery of plans”.

Greenwich also identified a “significant gap” between provider and commissioner activity plans, while Wiltshire providers said “we don’t fully recognise all the numbers”.

The approved plans also show that all five fast-tracked areas are planning to pool more than the minimum mandatory amount, with Sunderland pledging to create a shared budget worth up to £170m, against a minimum requirement of £25m.

  • Update, September 18: The cross government better care fund taskforce has told HSJ that when the five fast track areas’ A&E activity forecasts are added together, the overall planned reduction in admissions across the total populations they cover is three per cent.
  • The task force also said that Wiltshire is aiming for a 3.7 per cent cut in A&E admissions. This is despite a passage in the Wiltshire plan saying their A&E forecast “assumes 2 per cent growth less 3.75 per cent reduction”.