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STPs will not succeed where BCF has failed, warn MPs

MPs have slammed the government for the failure of the Better Care Fund (BCF) to achieve any of its objectives, arguing that they are unconvinced that STP planning could succeed where the BCF had failed in integrating health and social care services.

In a report released by the Public Accounts Committee (PAC), it was also found that STP planning was neither inclusive or transparent enough, as it warned that local people were not fully consulted or involved with decisions about how health and social care services operated.

Originally, the fund was brought in to save the NHS money and ease pressure on hospitals by reducing emergency admissions, lessening the time patients waited to be discharged into community care.

But the BCF was described as little more than a “complicated ruse” to transfer cash from NHS England to local government services.

The committee also argued that no progress had been made on achieving the BCF’s ambitions, saying: “Two years ago, we expressed serious doubt that the government's latest integration initiative, the BCF, would save money, reduce emergency admissions to hospitals and reduce the number of days people remain stuck in hospital unnecessarily.

“Since then the Fund has failed to achieve any of these objectives and our witnesses displayed an appallingly casual attitude to the targets that had been set for reducing emergency admissions and delayed transfers of care, both of which have actually increased.”

It also warned that the BCF has been rendered largely redundant as a means of building integration through STP planning processes, as NHS England prepared to roll out new care models across the 44 STP areas.

Government departments as well as NHS England were also sharply criticised for “washing their hands” of accountability for the fund, with the PAC citing NHS England’s chief executive Simon Stevens’s rejection of any responsibility for the success of the Fund last year.

However, an NHS England spokesperson questioned PAC’s findings, arguing: “It seems odd for a report to simultaneously claim that the original BCF was a ‘complicated ruse’, but then go on to criticise public servants for being frank about its operation.

“When called to give evidence before Parliament we make no apologies for responding to questions honestly and openly."

BMA: Health and social care ‘failed’ by party politicians

Dr Mark Porter, council chair of the BMA, claimed that PAC’s findings reiterated what the organisations had said for some time: that using the BCF to prop up social care budgets would only place further pressure on an NHS already at “breaking point”.

“This report also highlights the huge holes in planning for adequate social provision in STPs, with areas piloting new care models seeing slower growth in admissions and delayed transfers of care,” he added. “To roll out these plans without evaluating them first smacks of short term-ism.”

The BMA council chair also argued that given the scale of the savings required in each area, there is a real risk that STPs will be used as a cover for delivering cuts, starving services of resource and patients of vital care.

“The current crisis in social care is a direct result of inadequate funding, and failures within the system hugely affect an already overworked and underfunded NHS,” Dr Porter continued. “Any further delay in providing much-needed funding will have significant impact on the delivery of health care.

“Our health and social care systems have been failed by party politics for far too long. In the run-up to the general election, we need politicians from all sides to outline credible, long-term solutions to the challenges facing health and social care.”

And Saffron Cordery, director of policy and strategy at NHS Providers and a member of the NHE Editorial Board, commented that though the Fund has helped to forge closer links, it would not be successful delivering integrated care by itself.

“There are inextricable links between health and social care,” she explained. “Evidence shows that integrated services can provide a better experience and improved outcomes for patients. However, it is less clear how much – if at all – this reduces costs or pressures on hospitals.

“We agree that there is a need for a clear and agreed assessment of the cost of social care to the NHS. We also need a long-term and sustainable funding solution that brings together NHS trusts and local authorities.”

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