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Overambitious estimates result in £1bn less for Better Care Fund


10 July 2014

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The government have now declared that £900m will go towards the Better Care Fund, despite initial estimates stating that £1.9bn would be slashed from NHS commissioning budgets and used for the fund.
NHS England had been told in June 2013 that the 1.9bn budget cut would be given to local authorities (LAs) to form the £3.8bn Better Care Fund, starting from April 2015.

The government have now declared that £900m will go towards the Better Care Fund, despite initial estimates stating that £1.9bn would be slashed from NHS commissioning budgets and used for the fund.
NHS England had been told in June 2013 that the 1.9bn budget cut would be given to local authorities (LAs) to form the £3.8bn Better Care Fund, starting from April 2015.
The Nuffield trust, an independent health policy think tank, had advised that the proposed savings were extremely overambitious and would require the equivalent of a 15% reduction in the number emergency admissions.
A Cabinet Office review in May 2014 decided that due to the lack of detail in how the money would be saved, the investment cuts were not realistic and subsequently the Department of Health (DH), the Department of Communities (DC) and local government had to concede that a revision to the fund was required, resulting in £1bn remaining within the NHS.
Director of policy at the Nuffield Trust, Judith Smith, underlined the reality of the task ahead for the NHS and LAs, despite announcement of the changes to the fund on 5 July 2014.
She said: “The task ahead is not an easy one. The revised plan assumes reductions in emergency admissions of 3.5%, which would require local authorities and the NHS to buck a long term trend. As research to be published this week by the Nuffield Trust will show, emergency admissions rose 1.8% in 2012-13 and 0.4% in 2013-14. So just holding them flat would be a major achievement. What’s more, we know from extensive research that initiatives designed to develop better coordinated care outside hospitals are rarely able to reduce emergency admissions in the short or medium term.”
A DH spokeswoman took a more optimistic view, explaining that the integrated care achieved through the Better Care fund will result in long-term future savings through a reduction in emergency admissions and reduced demand for these emergency departments, GPs and community services.
Health and wellbeing boards, consisting of LAs and NHS commissioners have agreed to the amendments to the fund, which include targets to cut hospital admissions but at least 3.5% or by 185,500 people nationally.
From the £1bn that will remain within the NHS, £400m will be set aside to pay to be used if hospital admissions do not fall by the expected amount, whilst £600m will be invested into NHS non-acute services.
If emergency admittances fall by the projected 3.5%, then the health and wellbeing boards are free to use the £400m as they wish. 
The Health Secretary, Jeremy Hunt said: “Local authorities and the NHS are making excellent progress in developing plans that will give patients better, joined-up care and allow hospitals to focus on treating the people who really need to be there. The plans are packed full of ideas and show that strong partnerships are being forged with different teams like never before.”
“Successive governments have talked about bringing the NHS and social care together for decades. This is the first transformative step to making that a reality.”

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