Hospitals will get the chance to check and challenge plans to cut emergency admissions drawn up for the government’s £3.8bn better care fund, new Department of Health guidance reveals.

Guidance published last week by the Local Government Association and NHS England said councils and clinical commissioning groups would be required to share their forecasts for reductions in emergency hospital admissions with local acute providers.

Providers would be asked to submit a “commentary” on these forecasts, in which they must “confirm the extent to which they agree with the projections” and say whether they have built the same assumptions into their own two year plans.

These commentaries are expected to prove highly influential when the Department for Communities and Local Government and NHS England decide whether to sign off local plans.

Earlier this year, the Foundation Trust Network warned that “not enough providers are being engaged in a meaningful way in their local [better care fund] plans”, adding that its own research found just 54 per cent had been involved in the development of plans and just 2 per cent had been “fully involved”.  

The new requirement comes weeks after ministers announced a set of restrictions on the use of NHS money from the better care fund.  

This included a requirement for £1bn of the fund either to be spent on NHS commissioned out of hospital services, or to be paid out based on meeting targets for a reduction in emergency hospital admissions.

Andrew Ridley, managing director of North and East London Commissioning Support Unit, has been drafted in to oversee the fund as programme director.  

In a letter to council chief executives, CCG clinical leads and accountable officers, NHS England regional teams and health and wellbeing board chairs, Mr Ridley said the better care fund was “one of the most ambitious programmes in the history of the NHS and local government”.

He said the new rules on sharing forecasts with hospital trusts were a “crucial change” that aimed to “encourage greater provider engagement” in the plans.

In the letter Mr Ridley said HWBs’ original better care fund plans - submitted in April - “contained many excellent examples of innovative, integrated care”. However, he warned they needed “more evidence of robust finance and activity analytical modelling” and more evidence of provider engagement.

A guidance document outlining the changes said boards had until 19 September to re-draft their fund plans in line with the new restrictions. They would be offered “two tiered” support by the LGA and NHS England in the form of general support available to all and “bespoke” support for areas in need of more help.

It said revised plans would be subjected to an “intensive two-week desktop review” before being submitted to NHS England chief executive Simon Stevens and Department for Communities and Local Government permanent secretary Sir Bob Kerslake for “sign off”.

The guidance document also said:

  • “Ministers are clear that plans will need to be revisited to demonstrate clearly how they will reduce total emergency admissions, as a clear indicator of the effectiveness of local health and care services in working better together to support people’s health and independence in the community.”
  • “The expected minimum target reduction in total emergency admissions will be 3.5 per cent for all HWB areas, unless an area can make a credible case as to why it should be lower. All areas can set more ambitious targets should they wish, and the amount of funding linked to performance will increase accordingly.”
  • “All plans will be expected to clarify the level of protection of social care from the £1.9bn NHS additional contribution to the [better care fund], including that at least £135m has been identified for implementation of the Care Act.”
  • Plans must explain “the financial impact on local authority’s budgets resulting from changes to the [better care fund] policy since April 2014”.