Nuffield Trust statement on Better Care Fund changes

Responding to the revisions to the Better Care Fund, set out by the Department for Health, Dr Judith Smith of the Nuffield Trust provides a response.

Press release

Published: 07/07/2014

Responding to the revisions to the Better Care Fund, set out by the Department for Health, Dr Judith Smith of the Nuffield Trust said:

“The Better Care Fund, whilst sound in principle, was built on unrealistic assumptions about the in-year savings that could be achieved by reducing emergency admissions to hospital.

“It’s therefore good to see that the Government has listened to the concerns we and others raised about the impact the Fund could have on hospital finances in 2015/16, which is looking to be a crunch year for the NHS.

“But we should be under no illusion: 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.

"Because this latest change to the Better Care Fund requires local authorities to transfer money back to the NHS if emergency admissions are not reduced, it is likely that they will find themselves on the hook to hand up to £1bn back to the health service in a single year.

“This will come just as local authorities are using money transferred from the NHS to put in place new services for frail older people at risk of being admitted to hospital. It has the potential to be hugely destabilising for local authorities, when they are already under intense financial pressure.

“The Government is right to be looking to boost out-of-hospital care to manage demand on the NHS. But extensive evidence shows that this kind of change takes time. Expecting any savings in the short-term is looking increasingly unfeasible.”

Notes to editors

  • On Thursday 10 July the Nuffield Trust will publish Into the Red, which sets out a comprehensive overview of the NHS’s finances at a time of rising demand for health services.
  • 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.
  • The Nuffield Trust is an independent healthcare think tank. It conducts cutting edge research and influential analysis, informs and generates debate, supports leaders, and examines international best practice.