The planning process for the £5.3bn better care fund has been branded a “shambles” after a National Audit Office report pinpointed a series of problems with its implementation.
The spending watchdog’s paper, published today, found only £55m of “credible” savings had been put forward in the first round of local plans for the scheme. This is despite assumptions in the 2013 spending round the programme would save £1bn over the course of 2015-16.
The paper also raises concerns about the assumptions the fund would save the NHS more than £300m next year.
Chair of the Commons public accounts committee Margaret Hodge said she was “dismayed that planning for the better care fund has been such a shambles”.
She accused government departments of “incompetence” that was “unacceptable at a time when the number of people most likely to need care is rising, and overall funding is falling”.
The fund aims to join up health and care services by pooling budgets between councils and the NHS.
Current plans forecast £532m in savings, of which £314 million would be saved for the NHS from fewer emergency admissions to hospitals and fewer delayed transfers from hospitals.
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However, the NAO report warned there was “limited evidence that integrated care is effective in reducing emergency admissions sustainably, improving outcomes for patients, and saving money”.
It said: “Acute providers have fixed costs; there is uncertainty over reductions becoming sustainable; and large scale changes are needed to decommission services. These facts suggest that saving £300m in 2015-16 is ambitious, even if emergency admissions do reduce overall by 3.5 per cent.”
The NAO said the government’s decision this spring to “pause and redesign” the scheme, which led to new restrictions and a requirement for health and wellbeing boards to submit revised plans in September, was “the right thing to do”.
However, the report found, the decision to rethink the programme “reduced from 11 months to five months the time available for local areas to prepare for the implementation of the fund from April 2015”.
The office also found the better care fund was set up with “no central programme team, no programme director and limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support”.
It said: “The departments and NHS England therefore underestimated the complexity and challenge of bringing together the different health and social care organisations around a single local vision in a relatively short time.”
Amyas Morse, head of the National Audit Office, said: “The better care fund is an innovative idea but the quality of early preparation and planning did not match the scale of the ambition.”
A government spokesperson said it disagreed with the NAO’s criticism of the early stages of the programme.
“This is the most ambitious plan to transform care ever undertaken and we ensured detailed work took place a year ahead of the launch to allow us time to iron out the issues that the NAO itself now acknowledges have been addressed,” she added.
“We welcome this report’s conclusion that the Better Care Fund is an innovative programme providing better, more joined up care to help older and vulnerable people stay at home with dignity and independence. Local areas’ plans show how they will transform services to cut around 160,000 emergency admissions just next year and help people get home from hospital more quickly when they do have to be admitted.
“Last month over 97 per cent of local areas had their plans approved, ensuring that people will be able to get seven-day care services that work for them and saving an estimated half a billion pounds of taxpayers’ money too.”