Exclusive: Social care to benefit most under better care fund

At least £2bn has been earmarked to be spent on social care services in better care fund plans, £900m more than authorities plan to funnel into the fund and four times the sum hospitals are expected to save from reduced activity.

The figures come from NHS England’s analysis of better care fund data, seen by HSJ, combining figures from the 151 local plans produced by health and wellbeing boards.

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It is the first time a national breakdown of how pooled funds will be spent across the country has been made available.

The figures show that of the £5.3bn to be pooled by councils and clinical commissioning groups, £2.07bn will be spent on social care services and £1.66bn will go to community healthcare services provided by the NHS.

Some £744m has also been earmarked for “other” services, which cannot be definitively identified as being only health or social care and may include elements of both. This means the total spent on council commissioned services is likely to exceed the stated £2bn figure.

Of the remainder, £800m is made up of cash allocated to other sectors within the NHS such as mental health, primary care and acute services.

While the government imposed a minimum statutory requirement on the fund of £3.8bn, many CCGs and councils added in extra funding voluntarily.

The NHS England data reveals 64 health and wellbeing boards have agreed to share extra cash and that extra contributions offered by NHS and local authority commissioners were closely matched, with CCGs contributing £740m extra and councils adding in £750m.

Of the total £5.3bn planned spend, £4.2bn has come from the NHS and £1.1bn from local authority commissioners.

As the NHS England data shows a planned £2bn social care spend, this leaves local authorities with £900m more than their collective contribution.

HSJ understands that NHS England does not know how much of this £2bn will simply support existing services – effectively using NHS money to cross-subsidise council budgets – or how much will help create new or expanded social care services.

The commissioning body is also unaware of how much of the 2015-16 pooled budget will be spent on services that councils were already commissioning with other funding.

The extra investment in social care is also greater than the amount of projected savings set out in local better care fund plans, which nationally add up to £532m.

This suggests the NHS could be a net loser as a result of the initiative.

David Pearson, chief executive of the Association of Directors of Adult Social Services, told HSJ: “I would accept this is a net loss to the NHS.

“Some of it is for new services, but some of it is to prevent even deeper cuts to social care that, if they happened, would make it even harder for the system to function.” 

However Richard Humphries, assistant policy director at the King’s Fund, said: “I would have thought most of the additional money would be coming from joint agreements that local authorities and CCGs had in joint agreements anyway, before the better care fund.

“A lot of people have money tied up in agreements covering continuing health care, or mental health… I suspect places with a good tradition of pooled budgets would have rolled those into their fund plans.”

Saffron Cordery, director of policy and strategy for the Foundation Trust Network pointed out the better care fund was not “new” money, and said investment was needed to build capacity for community services to adopt a more preventative approach and cut length of stay in hospital.

She said: “This will require sufficient investment and a realistic timeframe for delivery across the all parts of the NHS… as well as provision to run existing services whilst new ways of delivering services are put in place.”