MPs warn of ‘significant increase’ in pressure on social care

By The Press Association26th February 2015News EnglandBetter Care Fund, Business / Funding / Finance, Finance, News England, Social Care

MPs have warned of a potential “significant increase” in pressure on adult social care as a result of switching the focus of a key Government scheme to slashing NHS costs.

The Better Care Fund is intended to reduce the burden on hospitals by pooling health and social care resources across England to help treat more people at home and free up beds.

But it was dubbed a “shambles” after it emerged local bodies had not been told it was also supposed to produce a £1 billion saving for the NHS and they were forced back to the drawing board.

Revised plans from all 151 health and wellbeing boards are expected by officials to see £5.3 billion of funding pooled and save £532 million in 2015/16.

But the Commons public accounts committee (PAC) cast doubt on whether that was achievable and warned that it remained unclear how social care would be protected in some areas.

It launched an inquiry in the wake of a highly-critical report by the National Audit Office (NAO) public spending watchdog into what it said were fundamental failures in the planning of the scheme.

The NAO said it would be a “struggle” to meet a target of reducing emergency admissions by 3.5% and that even revised savings were “bold assumptions … based on optimism rather than evidence”.

Such was the switch in focus, the PAC said in its report, that local government chiefs had considered walking away altogether because it “moved the integration agenda backwards not forwards”.

“We are concerned that the new focus on reducing emergency admissions and making savings will significantly increase pressure in adult social care services,” the MPs concluded.

The changes and delay caused by “deeply flawed” planning had “eroded goodwill and put delivery of the fund’s objectives at risk”, they went on

“Until NHS England’s intervention in April 2014, local authorities expected to have unrestricted access to a pooled budget which was around £1 billion larger than it was after the reset.

“It appears to the committee that NHS spending was judged a higher priority than supporting adult social care, and 14 local plans still present serious concerns with regard to the protection of adult social care in those areas.

“It appears likely that the fund will not, therefore, support adult social services to the extent originally anticipated.

“We are not convinced that it is possible to reduce emergency admissions and to deliver £532 million of savings in 2015-16, as the scale of the challenge in reversing the long-term upward trends in emergency admissions and delayed discharges is significant.”

Committee chair, Labour’s Margaret Hodge (pictured), said: “The Better Care Fund is meant to transform local health and social care services by pooling resources.

“However, with the redesign of the Fund after April 2014, the priority has shifted from improving local services through integration to protecting NHS resources.

“The failure to be clear with local areas about the expected savings severely undermined the initial planning process.

“As a result, all 151 health and well-being boards had to submit revised plans, resulting in wasted time, effort and money.”

She added: “The Local Government Association considered that the redesigned scheme moved the integration agenda backwards and not forwards, and it told us that local government had contemplated walking away from the Fund.

“Local areas are now at greater risk of not being able to implement the policy.

“It is not yet clear how all local authorities will protect adult social care services to the extent intended. At the time of the hearing, fourteen local plans presented serious concerns with regard to the protection of adult social care in those areas.

“All the agencies involved need to rise to this challenge as failure, particularly for older and disabled people, is not an option.

“The Departments should publish an annual scorecard to demonstrate the extent to which the Fund is supporting integration, maintaining adult social care, reducing emergency admissions and saving money.”

Ministers were also accused of “double counting” – including pooled resources in both council and NHS spending power – in a bid to hide a severe funding squeeze.

Clive Betts, who chairs the communities and local government committee, said it had heard evidence of a “clear case of Government double counting.

“Better Care Fund money is included within both the NHS budget and local authorities’ spending power.

“The Government is spending the same money twice in a desperate effort to mask reductions in local authority spending while seeking to show that it is maintaining NHS funding in line with inflation.”

He said the PAC investigation had raised “serious concerns”.

“Given the fund is supposed to be about integration and joined-up working, the lack of communication between central government departments is deeply troubling.

“DCLG (Department for Communities and Local Government) appears to have been blithely unaware that the Department of Health was planning to make £1 billion of savings from the fund.

“The resulting shifting of the goalposts has caused local areas frustration, delay and uncertainty.”

A Government spokesman said: “The £5.3 billion Better Care Fund is the biggest ever national programme to join up health and social care, will help more people to stay at home with dignity and independence, has the potential to cut around 160,000 emergency admissions and get people home from hospital more quickly when they do have to be admitted.

“All areas have now had their plans approved and are on course for the April 2015 launch of the Fund. This will ensure that people will be able to get seven-day care services that work for them and could save half a billion pounds of taxpayers’ money in the year ahead.”