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Better Care Fund target to cut emergency admissions by 3.5% a ‘triumph of hope over reality’



NHS England’s proposed 3.5% reductions in emergency admissions are based on ‘optimism rather than evidence’, a National Audit Office report has said.

The NAO’s report on the Better Care Fund – the £5.3 billion fund to integrate health and social care budgets – also estimates the savings to be made from intergrating care and reducing numbers of emergency admissions to hospitals to be around £532m, almost half the initial £1bn assumption.

Even these savings may be overly ‘optimistic’ as they rely on emergency admissions being reduced by 3.5% within one year, in defiance of the long-term trends of increasing admissions.

MPs said they were ‘dismayed’ by the implementation of the Better Care Fund, which they described as a ‘shambles’.

The fund was created from the pooled budgets of CCGs and local authorities, and hoped to create a £3.8bn pot for funding integrated care schemes, which included £1.9bn being recouped from existing NHS and social care budgets through efficiency savings.

Last month health secretary Jeremy Hunt announced the total pot had grown to £5.3bn.

The BCF has already been delayed after a Cabinet Office report found that plans to fund the pot through hospital efficiency savings lacked financial ‘credibility’.

The latest NAO report said that the Government’s projections were questionable.

It states: ‘Nevertheless, the fund still contains bold assumptions about the financial savings expected in 2015-16 from reductions in emergency admissions, which are based on optimism rather than evidence, and implementation faces further hurdles.

‘The national planning assumption that emergency admissions will fall by 3.5% in one year is ambitious given the long-term trends. Emergency admissions increased by 47% over the 15 years to 2012-13.’

It also highlights a recent Department of Health commissioned study which concluded integrated health and care funds of this sort ‘seldom led to improved health outcomes’ or ‘long-term reduction in hospital use’.

Commenting on the report, chair of the Public Accounts Committee Margaret Hodge MP said: ‘The integration of health and social care is fundamental to delivering more efficient and effective NHS and social care services to meet the growing needs of our population.

‘So I am dismayed that planning for the Better Care Fund has been such a shambles.’

Ms Hodge added: ‘Furthermore the assumption that local areas can achieve a reduction in emergency admissions of 3.1% is a triumph of hope over reality.’

Richard Humphries, assistant director of policy at The King’s Fund reiterated calls for new investment in the NHS, rather than more recycled funding.

He said: ‘Given the tight timescales and absence of any new money in the Fund, local areas are being expected to achieve too much, with too little, too soon.’

An NHS England spokesperson said: ‘The local Better Care Fund plans signal the beginning of a profound redesign of services, dissolving outmoded demarcation between health and social care. No one should pretend this is easy, but nor should we ignore the widespread consensus that doing so is critical for the millions of people the NHS is here to serve.’