NHS England is seeking a freeze in the sum the NHS is required to pool with local government in the better care fund, HSJ has learned.

  • NHS England seeks freeze in better care fund value in spending review negotiations
  • Health secretary previously said fund should be “extended”
  • National body is calling for social care to be funded properly, not through transfer
  • Scrapping the fund assurance process also under consideration

It is one of the requests from the national body in negotiations for the government’s comprehensive spending review in November, several senior sources confirmed.

The better care fund, designed to fund social care and out of hospital support services, was a flagship health and care policy of the coalition government, and featured in the Conservative manifesto.

In April, Jeremy Hunt told HSJ it meant social care would benefit from the £8bn real terms spending growth his party promised to the NHS between 2016 and 2020. The health secretary also said: “I think [the fund] will be extended and accelerated because for all intents and purposes we are now saying that we want to fund a fully merged health and social care system.”

However, several sources with knowledge of negotiations told HSJ that NHS England was asking for the national minimum better care fund sum to remain fixed at £3.8bn in 2016-17, and ideally for it not to be uplifted with inflation.

It has argued both NHS and social care services need to be properly funded independently, not through a larger transfer. NHS England agrees with local government and social care representatives that greater funding is needed for care, as services are suffering and some are at risk of crisis. Sources said it was “ridiculous” to think this could be sufficiently addressed through the better care fund.

NHS England has also pointed out that its forecast that the health service needed £8bn real terms funding growth by 2020, made at the publication of the NHS Five Year Forward View last year, depended on the availability of social care services, and did not account for a growing better care fund.

Under NHS England’s request, clinical commissioning groups would still be free to pool larger sums voluntarily. For 2015-16 CCGs put in £740m more than required, and councils put in £750m. This takes the national better care fund sum to £5.3bn.

HSJ reported last year that at least £2bn of this was planned to be spent on social care services, with £744m designated for “other” services, some of which are expected to be social care related. Nearly £1.7bn was designated to community healthcare and £800m to other NHS services.

National discussions about the future of the fund also include the possibility of abolishing its laborious planning and assurance process and joining it with the main planning process. This idea is popular with all sides, but some separate process may be needed to manage the performance based element of the fund, which is £1.9bn this year. This approach means more money is kept to pay for acute services if targets for containing emergency hospital demand are not met during the year.

National health and local government leaders are expected to issue an update about the fund’s future next month but will not be able to set key details, including its total value, before the 25 November spending review.

Other points of contention in the spending review for the NHS are believed to include

A DH spokeswoman said no decision had been made about the size of the better care fund but pointed out that the Conservative manifesto had indicated it would continue next year. NHS England declined to comment.


NHS to be asked for four year plans

NHS England, NHS Improvement and other arm’s length bodies are expected to write to NHS organisations in coming weeks, independently of the better care fund work, to ask them to begin overall activity and performance planning. The process is likely to require high level plans for four years, and NHS England is expected to set clinical commissioning group allocations for four years after the spending review.

Discussions are ongoing about whether commissioners and providers will be required to submit new four year strategies for savings and service transformation next year, or just be encouraged to work on these locally, as they were in the 2015-16 planning guidance.