The planning process for the £5.3bn fund has been branded a “shambles” after the public spending watchdog a highlight a series of problems with its implementation, plus the rest of today’s news and comment

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4.16pm Here’s what Glen Burley, chief executive of South Warwickshire Foundation Trust, had to say:”I see the dilemma but there is a danger that we now cannot tell the difference between success and failure. Popular trusts struggle with the RTT target far more than unpopular ones and hence popular trusts face the prospect of fining. Perhaps more questions should be asked about the organisations that these patients are choosing to bypass.”

4.12pm Our story on three new trusts imposing referral restrictions is attracting a lot of comment. Here’s a selection:

“It is about time this became a problem for commissioners to resolve rather than providers. Expect more of this as the additional RTT money comes with performance strings attached and Monitor and the TDA are getting tougher on targets.”

3.45pm Monitor has announced it is opening an investigation into concerns about short-term financial problems at Yeovil District Hospital Foundation Trust.

The trust has been developing longer-term plans to improve how it works and to integrate care across South Somerset by working together with organisations including social services and GPs. However its short-term financial position has deteriorated.

Paul Streat, regional director at Monitor, said: “Our investigation will look at the trust’s short-term finances and see how it can be improved to best support its long-term plans.”

3.04pm There has been a lot of reaction online to news that Mark Newbold, chief executive of Heart of England Foundation Trust, is stepping down from his position.

Here are some views from Twitter:

2.45pm Too often politicians support short sighted but popular ideas, which is good politics but leads to bad policy, writes Michael White, in his weekly HSJ column.

2.38pm In The Daily Telegraph, ‘hip-hop therapy’ could help people with depression or mental illness, according to psychiatrists at Cambridge University.

 2.24pm The Guardian reports that portrayals of people with mental health problems in televisions programmes such as Homeland are contributing to a better understanding of the conditions, and in some case encouraging people to seek help, according to a report commissioned by the Time to Change campaign run by the mental health charities Mind and Rethink Mental Illness.

Martin McShane, NHS England’s director for people with long term conditions said: “It’s great to see these issues being highlighted on prime time television.

“We want to reduce the stigma around mental ill health and encourage people to seek help as soon as they can. Featuring these issues in an authentic way can help to drive these messages home.”

1.12pm UKIP has defended a its leaflet for the Mark Reckless’ campaign in Rochester and Strood following claims by Medway Trust that a photograph used in the leaflet implied its support for the party, the BBC reports.

Mr Reckless said: “The photograph in no way implies that Dr Barnes supports me in this election or otherwise, senior NHS staff of course being politically neutral.

“The text does, however, I hope make clear my support for Dr Barnes and his team at the hospital.”

Mr Reckless said the leaflet in which the photograph is appeared had been fully distributed, however it would the photograph would not be used any further campaign leaflets.

1.01pm The Spectator reports that Mark Reckless, UKIP candidate for the Rochester and Strood by-election, has been criticised by Medway Trust for suggesting it supported his election campaign.

One of Mr Reckless’ campaign leaflets featured him alongside the trust’s chief executive Phillip Barnes, while he was still Conservative MP for Rochester.

Trust chair Shena Winning wrote to Mr Reckless over the weekend saying she was “extremely concerned, and surprised” to see the photograph being used in the editorial, which was “inferring that both Dr Barnes and the hospital were supporting Mr Reckless’ campaign”.

She called for  the immediate withdrawal of the leaflet, confirmation in writing that the leaflet will be withdrawn, and a public retraction in the Rochester and Strood media.

You can read the full letter here.

12.45pm Writing in The Daily Telegraph, Martin Brunet, a GP in Guildford, describes how he does not want a £55 “bribe” to diagnose dementia in patients.

The policy was introduced by NHS England last month, prompting criticism from GPs and dementia experts.

Dr Brunet argues that “what the NHS has not done is listen to why GPs might be reluctant to refer their patients to “memory clinics” – or why our patients might not want to go.”

He claims “what memory clinics have to offer is just not good enough”.

“It can be difficult to persuade a frightened patient to go to the psychiatric hospital for a memory assessment, and when you know the post-diagnostic support will probably amount to nothing more than a prescription and six-month follow-up, the task becomes impossible.

“Diagnosis is nothing without support, and to make a real difference in dementia care we need a revolution in what happens after a diagnosis is made.”

12.36pm In Resource Centre today, with public health now settled in local authorities, a strategic approach can achieve tangible results in reducing health inequalities, write Vivienne Robbins, Mike Sandys and Dr Peter Goldblatt of the UCL Institute of Health Equity.

12.33pm The BBC reports that the Supreme Court will hear legal arguments on whether midwives have a right to refuse to take part in abortion procedures on moral grounds.

NHS Greater Glasgow and Clyde made the apeeal to the UK’s highest court, after judges in Scotland ruled that two Roman Catholic midwives had a right to conscientious objection.

The case will be heard by five judges and a ruling is expected next year.

12.11pm A psychologist who claimed she faced detriment at the hands of an NHS trust after whistleblowing about patient care has lost her case.

Psychologist Hayley Dare claimed she was bullied at West London Mental Health Trust when she made allegations about poor patient care and staff welfare.

But the chair at Watford Employment Tribunal, Ian Henry, today said Dr Dare was prompted to make the claims by being “particularly distressed”’ when she thought she was to have six of her psychology sessions cut, which would have had a significant impact on her job.

11.56am Clinical commissioning groups will not be awarded extra funding to run primary care co-commissioning, NHS England has confirmed.

In a paper outlining the next steps towards commissioning, NHS England says there is “no possibility of additional administrative resources being deployed on these services at this time due to running cost constraints”.

The paper however hints that this situation could alter in the second year of its co-commissioning scheme. “Whilst it is not within our gift to increase running costs in 2015-16, NHS England will keep this situation under review.”

11.47am The King’s Fund has published a report ‘Commissioning and contracting for integrated care’ which looks at the risks and benefits of using different contractual vehicles to stimulate and support integrated care.

The report investigates how commissioners in five areas are using different contracting models to drive integrated care and draws four key observations from the evidence. It says commissioners should:

  • continually engage with providers, patients and local communities to identify problems and appropriate solutions
  • ensure whether a contractual solution is appropriate and proportionate for addressing the need at hand
  • develop an approach to contracting that is not purely transactional, but which builds trust and nurtures relationships
  • enable providers to develop robust governance to meet the needs of the contract and align payment mechanisms and incentives

11.40am Here’s what Nigel Edwards, chief executive of Nuffield Trust, had to say about the NAO’s findings:

“The NAO is right to highlight the over-optimistic assumptions upon which the Better Care Fund is built. We warnedabout these before. Reducing emergency admissions to hospital is very difficult. Even where it works, it takes a long time and doesn’t necessarily save money.

“The government has taken steps to refine the policy after realising initial plans didn’t add up. But the scheme still banks on achieving a reduction in emergency admissions of over 3%. This is unprecedented in recent years. Because of the way the scheme is designed, missing the target will mean even more cuts to local authority budgets.

“There is no doubt that better joined up health and social care is the right goal. But the plan’s emphasis on bringing down delayed transfers from hospital to social care and reducing admissions to care homes are a better way achieve this than the hope that pooled budgets will result in fewer emergency admissions to hospitals.”

11.30am The NHS Confederation has commented on the NAO’s report on the better care fund.

Johnny Marshall, director of dolicy, said:

“We are pleased that the NAO report recognises the areas of concern we have highlighted on behalf of our members regarding the BCF planning, notably the tight timescales set  for submitting local BCF plans; the conflicting directives around the objectives behind the policy, the burdensome ‘tick-box exercise’ nature surrounding the planning process; and the frustration of local areas having to re-submit plans after the original April planning deadline. We also reiterate our concerns about the ability of some local areas to achieve the reductions in levels of emergency activity and financial savings that the BCF requires.

“We agree the BCF’s success rests on “assumptions” which “may still  be over-optimistic” regarding the ability of integrating services to reduce costs. It is our view that whilst there is much evidence that greater integration and personalisation improves outcomes, the evidence that it delivers financial savings is still in its early stages. It will take time for the new models of care to allow us safely to disinvest in existing services. This is why we will need financial flexibility and extra resources to allow double running of some services while we move to the new models of integrated care. This will require us to consider health and social care spending together.

11.12am NHS England is to start evaluating the cost effectiveness of medicines available through the cancer drugs fund in a bid to bring the spiralling budget under control.

A number of drugs currently available through the controversial fund are expected to drop off the list as a result of the overhaul agreed by NHS England’s board last week.

As well as considering the cost of drugs for the first time, its new standard operating procedure for the fund will also raise the threshold for clinical effectiveness.

10.50am Responding to the publication of the National Audit Office’s report on the Better Care Fund, Richard Humphries, assistant director, policy at The King’s Fund said: “The introduction of the Better Care Fund at a time of mounting financial pressures on the NHS and social care carries significant risks.

“Although the recent changes made to the operation of the Fund go some way to easing concerns about its impact on the NHS, they represent a substantial shift of risk back to local authorities and leave local areas just five months to prepare to implement their plans.

“Given the tight timescales and absence of any new money in the Fund, local areas are being expected to achieve too much, with too little, too soon. Achieving the headline ambition of reducing emergency admissions by more than 3 per cent would require a dramatic reversal in demand for hospital services which has been rising inexorably in recent years.

“While we welcome the Better Care Fund as an important step towards a single budget for health and social care, it is not a substitute for the new funding needed to invest in essential changes to services. A new transformation fund is needed to help meet the costs of developing new community-based services and cover double running costs during the transition between old and new models of care.

“In the long term, as the Barker Commission recommended, a new settlement is needed to place health and social care on a sustainable footing.”

For further information or an interview please contact the press team on 020 307 2585 or respond to this email.

10.46am The regulator Monitor is advertising for senior roles with clincian backgrounds. The organisation has been criticised in the past for not having enough senior staff with past medical experience.

10.37am Three further trusts have imposed controversial curbs on patient access to services by restricting referrals from outside of their catchment areas, HSJ has discovered.

Hull and East Yorkshire Hospitals Trust, Oxford University Hospitals Trust and Salford Royal Foundation Trust have all blocked some referrals as they sought to throttle demand over the past year.

They bring to four the number of trusts known to have restricted out of area referrals.

As reported by HSJ in September, University Hospitals Birmingham Foundation Trust has begun blocking routine referrals from outside the area across several specialties in a move which has raised concerns about patients’ choice.

10.33am 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”

10.26am This afternoon senior health economists will be giving evidence to the Commons health committee as part of its second oral evidence session on public expenditure on health and social care.

The session will begin at 2.30pm, with the committee hearing from John Appleby, chief economist at the King’s Fund, Anita Charlesworth, chief economist at the Health Foundation and Nuffield Trust chief executive Nigel Edwards.

More details here.

10.20am The chief executive of a large Midlands hospital trust has announced he is stepping down.

Staff at Heart of England Foundation Trust were told today that chief executive Dr Mark Newbold was resigning.

The news comes after the trust had a condition placed on its license by Monitor on 24 October, citing poor performance on waiting times and mortality.

In his resignation letter, published on his blog, Dr Newbold said overcrowding was the worst problem his trust faced and if he had managed to solve it he “would not be writing this letter.”

10.15am Commenting on the National Audit Office report, Planning for the Better Care Fund, Chris Hopson, chief executive of the Foundation Trust Network, said: “Today’s report from the National Audit Office underlines what we have consistently said about the objectives, evidence, risks and management of the better care fund.

“We fully support the underpinning aspiration of the better care fund to better integrate health and social care for patients. However the pooled fund of £5.3bn for health and social care, is not ‘new’ money, and comes at a time when health and social care services are overstretched and facing rising demand.

“To date, the overall emphasis has been for better care fund investment and integration to solve the problem of rising rates of emergency admissions. However, we also need to focus on building capacity in the community for a more preventative approach, including working with social care and primary care colleagues and facilitating greater support based around the home if we are to manage demand and move to 21st century models of care.

“Whilst we agree with the need to improve care for patients by bringing health and social care together, all the international evidence says that such a major change needs time, investment and double running costs while new ways of delivering services are put in place.

“It will be important to learn the lessons of the better care fund process and ensure all NHS providers are fully engaged in any process to transform local care pathways for patients and to integrate care.

“Though well intentioned, many of our members question whether the better care fund is the best driver to integrate health and social care at a time when the demands on the NHS are already excessive.”

10.10am A link to the published report can be found here.

10.08am The watchdog said that early local plans for the Fund, which will pool £5.3bn of existing NHS and local authority funding in 2015-16, did not meet ministers’ expectations or generate the level of savings the government expected and all plans had to be resubmitted.

Although the Government’s early planning assumption was that the Fund would save the NHS £1bn in 2015-16, current plans forecast at least £314m of savings for the NHS.

The Better Care Fund will run from April 2015. The Department of Health and the Department for Communities and Local Government developed the Fund’s policy, with NHS England and the Local Government Association responsible for the delivery and implementation of the Fund.

It was agreed that local areas would develop plans for spending the Fund with minimal central prescription, in order to drive local innovation from the bottom up, and reflecting the fact that no savings target had been formally agreed for the Fund during Spending Round 2013.

As a result, there was 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. In addition, the initial scheme guidance did not mention the scale of savings expected from the Fund.

All 151 local health and wellbeing boards submitted plans in April 2014 for how they would spend their Fund allocations in 2015-16. But NHS England concluded in May that the Fund plans would deliver only £55m of financial savings, not the £1bn the Department of Health and NHS England expected. The Departments concluded that the plans required further development and Ministers did not approve any plans in April, as originally intended.

Planning for the Fund paused between April and July 2014 while the Government reviewed and revised the Fund’s scope and how the £1 billion pay-for-performance part of the Fund would work.

In July 2014, the Departments revised and improved the Fund’s governance and programme management, requiring local areas to submit new plans in September 2014 for expected approval in late October. However these changes to the Fund 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 Local Government Association does not agree with the changes in the Fund’s scope. It has said that the revisions undermine the Fund’s core purpose as promoting locally led integrated care and reduce the resources available to protect social care and prevention initiatives.

Under the Fund’s revised conditions, local areas were asked to aim for at least a 3.5 per cent reduction in their total emergency admissions over 2014 levels. Expecting such reductions within one year is ambitious against a trend of rising emergency admissions and feedback from local areas suggesting that some areas will struggle to meet this target. Local areas have proposed reductions of 3.1 per cent.

Independent assurance of the September Fund plans found them to be stronger and better supported than the April plans. Almost two-thirds of plans were either approved by Ministers or approved with support and only 5 plans were not approved. The biggest risk area identified is to the protection of social care services with 21 local areas assessed as having significant risks.

10.05am In a statement, Amyas Morse, National Audit Office comptroller and auditor general, 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. The £1 billion financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government’s confidence in the Fund’s value.Ministers were right to pause and redesign the scheme in April this year when they realized it would not meet their expectations. The Fund still contains bold assumptions about the financial savings expected in 2015-16 from reductions in emergency admissions. To offer value for money, the Departments need to ensure more effective support to local areas, better joint working between health bodies and local government, and improved evidence on effectiveness.”

10.00am Whitehall’s public spending watchdog has published a report today criticising the government’s planning and implementation of the better care fund, describing the early programme management as ‘inadequate’.

7.00am Good morning. A number of recommendations around the need for greater transparency and accountability in the health sector will shortly be brought into law.

Tony Yeaman argues it will be a real test for boards to ensure their organisations, their directors and staff are now ready, candid and fit for purpose. Getting it wrong could have significant implications for the patient, relevant director and organisation.