Care Bill: Consideration of amendments, House of Lords

This briefing gives key facts and outlines our position on the Better Care Fund and Trust Special Administration.


Published: 07/05/2014

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The House of Lords is set to scrutinise MPs’ amendments to the Care Bill. This briefing gives key facts and outlines our position on the Better Care Fund and Trust Special Administration.

Amendments to the Care Bill in the House of Commons have added and changed crucial parts of the sweeping reforms it lays out. Peers now have the important role of scrutinising these changes and deciding whether to agree, disagree, or suggest their own amendments.

The new part four of the Bill lays the legal framework for the Better Care Fund. This represents the Government’s flagship policy on joining up health and social care. By removing some NHS funding and putting it into a shared budget pool, it aims to encourage local authorities and NHS commissioners to work together.

Within the tight time frame laid out, projects under the Better Care Fund are unlikely to accomplish many of its key goals

There is no doubt that patients and service users need better integrated care to become a reality. However, we have serious concerns about whether this policy will succeed in some of its key aims, in particular the unrealistic targets set for reductions in emergency admissions to hospital.

There is a real danger that troubled NHS hospital finances will take a serious blow as the Better Care Fund makes limited progress towards building up care outside hospital.

Within the NHS, meanwhile, clause 118 of the Bill provides for a controversial extension of powers over failing hospitals to other hospitals nearby. When trusts are declared effectively bankrupt by the Secretary of State or regulators, this clause will allow Trust Special Administrators to recommend changes or downgrades to neighbouring hospitals.

MPs have agreed some important amendments to the Clause, but we believe more extensive changes are needed. It is true that the underlying problems in hospital finances often need to be tackled regionally.

However, the use of the fast-track Special Administration process does not seem appropriate for change to successful trusts. These changes should continue to use established processes, embraced by successive governments, which engage local communities and patients.

Suggested citation

Nuffield Trust (2015) Care Bill: Consideration of amendments, House of Lords. Briefing.