NHS: Better Care Fund

Viscount Bridgeman Excerpts

Thursday 3rd July 2014 Lords Chamber

[Viscount Bridgeman (Con)]

My Lords, I thank the noble Lord, Lord Kennedy of Southwark, for initiating this very important debate. He has rightly emphasised the need for early treatment of so many of the complaints which he outlined. It has long been recognised that there is a great need for integration of health and social care because this can support people better by improving their health and well-being by ensuring continuity of care while making better use of resources.

The basic mission of the better care fund is for health and care support to work together. From it flows, for instance, acting earlier and improving health education so that people can stay healthy and independent at home, thus easing the strain on hospitals and A&E, and from it also flows care which is tailored to individual needs with NHS and social care staff working together to provide seven-day services with a named co-ordinator.

The better care fund of course faces two challenges coming from very different directions. The first is the funding crisis common to the health sector and local authorities and the second is the increase in life expectancy mentioned by the noble Lord. Nevertheless it is a bold initiative. I welcome the tight but, I hope, not bureaucratic control over the operation of the scheme. One billion pounds of the fund will be tied to local performance. Peer support will be available to those areas which do not perform well. I also welcome the flexibility of the scheme by which £3.8 billion will be pooled in local areas, but the two services will be permitted to go further with additional funding where local conditions make this appropriate. There is a clear mandate for control of the funding to rest with NHS England which in turn will require clinical commissioning groups to use powers under Section 75 of the National Health Service Act 2006 to set up pooled budgets with local authorities. I welcome the checks and balances, for instance, that money from a pooled budget can be spent only with the agreement of both parties, with such spending agreed with the health and well-being board. In cases, which I hope will be rare, where the scheme is manifestly not working, it will be the duty of NHS England to intervene and instruct the CCG to come up with a solution.

Not for the first time, the King’s Fund has come up with a well researched document which draws together a number of studies relevant to the better care fund. It has produced a number of very practical suggestions for making this body viable and effective in its early years. The King’s Fund’s work contains its customary bibliography, and I am sure that the Minister, his department and, indeed, NHS England have taken note of the many constructive suggestions which it contains. The study fully acknowledges that this is a difficult time for the NHS in terms of funding. For instance, of the total of £3.8 billion budgeted for the fund, £1.9 billion will come from allocations to CCGs. It will not be new money. Guidance has come from NHS England that hospital emergency activity will have to reduce by 15%. We are in all-too-familiar territory here. Where patients go, whether to their GP or to A&E, justifies a debate on its own. Suffice it to say here that if the 15% reduction in emergency activity is to be reduced to assist the funding of the BCF, for the hospital it is a matter of considerable urgency.

Many of the recommendations contained in the King’s Fund document are contained in the admirable house of care programme developed by NHS England, which outlines so much of what the BCF should aim to achieve. I shall list only some of them: greater forward planning for LTC patients; involving patients in the self-management of their health; greater access by patients to their health records; agreed common goals for the NHS and care services; and emphasis on staff training. All these are common-sense aspirations—there is no rocket science here—but it is useful to have these brought together in a user-friendly document.

I return to the subject of the 15% reduction in hospital admissions. The Nuffield Trust, in particular, has made a study of more than 30 integrated care programmes, many of which had reducing urgent hospital admissions as a key goal. There have been a number of press reports suggesting that there is a real danger of financial collapse in the hospitals sector. I hope the Minister will confirm that across England there have been a number of pilot operations of the BCF model. I should welcome an update from the Minister on the results of these pilots and his reassurance that this very real problem relating to hospitals is being addressed.

Finally, I think it is true to say that attention has rightly been concentrated on getting the BCF off the ground in 2015-16 and in its first year of operation. Here I take up the point made by the noble Lord. I note that the Local Government Association chairman, Sir Merrick Cockell, while giving his strong support to the BCF is concerned about the longer-term funding, saying:

“Health and social care partners have shown their confidence in joining up their funding by putting in additional money over and above what was required by the Department of Health, but despite this there has still not been any indication that funding will be extended beyond this first year”.

I, too, hope the Minister will be able to say something about the Government’s plans for longer-term funding of the better care fund, the concept of which is welcomed from all quarters.