Nuffield Trust statement: Better Care Fund built on ‘flawed logic’

Nuffield Trust Chief Executive, Nigel Edwards, responds to reports that the Better Care Fund is being delayed.

Press release

Published: 07/05/2014

Responding to reports that the Government’s measures to join up health and social care through the Better Care Fund are to be delayed, Nuffield Trust Chief Executive, Nigel Edwards said:

“While nobody can argue with the very sound principle of bringing health and social care closer together, the Better Care Fund is built on flawed logic and the Government is right to review it.

“The Fund assumes that hospitals can quickly achieve a 15 per cent reduction in emergency admissions and that these reductions will result in savings in the same year, at full cost. But reducing admissions takes time, and lowering the types of admissions targeted by the Better Care Fund costs money. These assumptions are therefore wildly optimistic.

The Better Care Fund is built on flawed logic and the Government is right to review it

“The wishful thinking underpinning the Better Care Fund is more than just an inconvenience. With almost half of all acute hospitals already in deficit, there is a very real danger that shifting £1.9 billion largely out of the hospital budget, as this policy proposes, could lead to a widespread financial collapse across the acute hospital sector.

"The Cabinet Office is right to be asking searching questions about these plans. Simply expecting efficiencies from hospitals to deliver the savings needed for the Fund on top of already very challenging targets is not going to work. Delaying its implementation and focusing on how to get patients home from hospital more quickly should be a priority.

"A credible approach needs to contain the growth both in hospital admissions and the time patients stay in hospital, which, due to the ageing and growing population could result in a requirement for a further 15,000 hospital beds in the next seven years.”

Notes to editors

The Nuffield Trust has evaluated more than 30 integrated care programmes, many of which had reducing urgent hospital admissions as a key goal. We have found little evidence of cost-effective reductions in hospital admissions from such initiatives. This is partly as a result of commissioners being impatient for change in too short a timescale, and partly down to initiatives themselves often not being well designed to fit in with other services.