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Better Care Fund ‘unwieldy, time-consuming and bureaucratic’ – HFMA and CIPFA

Although the Better Care Fund (BCF) has begun to produce better working relationships between the NHS and public services, it is still being held back by too much red tape, a report by healthcare industry leaders has argued.

In the report, the Healthcare Financial Management Association (HFMA) and the Chartered Institute of Public Finance and Accountancy (CIPFA) said more needs to be done to simplify the Fund process to secure its long-term success.

Conclusions are based on a finance staff survey of NHS bodies and local authorities representing nearly one-third of BCF sites. There were some very positive responses, with many of the 48 respondents – representing organisations who account for £3.6bn of the Fund’s total value (£5.3bn) – saying they had experienced better dialogue across local public sector bodies.

But these successes were undermined by negative feedback, particularly on the complicated governance and unrealistic expectations.

Rob Whiteman, CIPFA chief executive, said: “Government must do more to support effective governance of the BCF. This is a real opportunity to get health and social care working together – focusing on prevention before cure – saving lives, time and money.

“I commend the aim of the BCF, but its administration must be simplified if it is to deliver a meaningful impact.”

While the health and social care community has embraced the BCF by pooling more money through it than the minimum required, local implementation arrangements differ considerably in structure and planning.

Several CCGs and councils formally require to take part, with many other partners and providers needing to be involved in the process. Arrangements in areas with unitary authorities, the report argued, are usually much simpler.

The level of bureaucracy behind the BCF was also criticised, with the Fund seen as “unwieldy”, “consuming a disproportionate management time”, and “coming with demanding metrics and oppressive reporting requirements”.

Similarly, its unrealistic expectations fuel disputes between partners, “giving integration a bad name”.

And importantly, the BCF has been criticised for adding to the current pressure on health finances, mostly because it reuses existing funding “while assuming it creates additional investment”.

The survey follow on from similar findings in February that the BCF’s initial planning was “deeply flawed”, and that it will not deliver even one-third of the planned £1bn savings as early preparations were inadequate.

Respondents therefore called for more clarity, simplification and recognition that joint working arrangements are difficult and time-consuming. One CCG said, for example, that “relationships begin to get tested when the money dries up”.

But they also acknowledged the benefits of integrating services, particularly where there is a common purpose that can benefit from joined-up posts.

Given this, the two industry bodies called on Whitehall to review the administrative and monitoring arrangements before 2016-17 in order to streamline the service, consulting on changes as early as possible.

Arrangements should also be modified continuously in order to keep up with the government’s devolution programme, which HMFA and CIPFA believe to be the “most sustainable model for taking forward integration at scale”.

Lastly, it should use the lessons already learnt from the Fund when developing arrangements for full health and social care integration plans, which the chancellor has requested by 2017, and implementation in 2020 – as reported by NHE’s sister title, Public Sector Executive.


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