Better Care Fund

Better Care Fund
Name	Better Care Fund
Formation	2013
Type	Policy initiative
Purpose	Integration of health and social care services
Region served	England
Parent organization	Department of Health and Social Care

Better Care Fund

The Better Care Fund is an English policy initiative created in 2013 to align resources between NHS England, local authorities, and social care providers to reduce hospital admissions, improve discharge, and integrate services for older people and those with long‑term conditions. The policy sits at the intersection of programmes such as the Five Year Forward View, Care Act 2014, and commissioning reforms by Clinical Commissioning Group bodies, while interacting with national regulators including Care Quality Commission and oversight from Her Majesty's Treasury. It convenes partnerships across stakeholders like Age UK, Royal College of Nursing, Association of Directors of Adult Social Services, and voluntary sector organisations such as British Red Cross.

Background and Purpose

The initiative emerged after policy reviews including the King's Fund analyses and reports by the NHS Confederation and the Institute for Public Policy Research that highlighted pressures on Accident and Emergency departments and delayed transfers of care from acute trusts such as University College Hospital and Addenbrooke's Hospital. It aimed to incentivise pooled budgets between NHS England and local government through mechanisms resembling arrangements in the Care Act 2014 and in response to demographic trends identified by the Office for National Statistics and forecasting by Public Health England. Early pilots drew on models from international systems like Torbay Care Trust and lessons from integration initiatives in Scandinavia and Canada.

Funding and Governance

Financial architecture combined capital and recurrent streams from NHS England baselines and improved Better Care Fund allocations negotiated with Her Majesty's Treasury and distributed via Clinical Commissioning Group allocations and grant mechanisms overseen by Local Government Association networks. Governance arrangements required pooled budget agreements under Section 75 of the National Health Service Act 2006 and joint governance boards linking elected councillors from county and unitary councils such as Kent County Council and Birmingham City Council with NHS commissioners and chief executives from acute trusts like Guy's and St Thomas' NHS Foundation Trust. National guidance was issued by Department of Health and Social Care policy teams and monitored through data returns to NHS Digital and performance dashboards used by bodies including NHS Improvement.

Implementation and Services

Local partnerships used pooled funds to commission services across primary care networks, community trusts such as Leicestershire Partnership NHS Trust, and third‑sector providers including Age Concern and Stroke Association affiliates. Typical investments included reablement services operated with providers like Home Instead Senior Care, rapid response teams modeled on Integrated Care Teams and intermediate care units adjacent to hospitals such as Royal Free Hospital. Schemes linked with General Practitioner practices and multidisciplinary teams involving Occupational Therapy professionals, Physiotherapy services, social workers accredited by College of Social Work standards, and technology solutions procured from suppliers of telecare used in pilots in Cornwall and Manchester.

Performance and Outcomes

Evaluation studies by organisations such as King's Fund, Nuffield Trust, and National Audit Office reported mixed results: reductions in delayed transfers of care in some localities (for example, Nottingham and Torbay) and modest shifts in emergency admission trends in areas like Camden, but less consistent evidence for widespread reductions in bed‑days across acute trusts including Birmingham Heartlands Hospital. Metrics tracked through NHS Digital included delayed transfers, readmission rates, and patient‑reported outcome measures used by Healthwatch England and local scrutiny committees. Some integrated care partnerships recorded improvements in patient experience surveys from Care Quality Commission inspections and increased uptake of preventative services.

Criticisms and Challenges

Critiques from organisations including the British Medical Association, Royal College of Psychiatrists, and Age UK pointed to shortfalls in social care capacity, workforce pressures in nursing and domiciliary care, and constrained capital for capital projects, echoing concerns raised in reports by Public Accounts Committee and House of Commons Health Committee. Challenges included complexity of pooled budget governance, variability in data quality submitted to NHS Digital, tensions between acute trust financial targets such as those faced by University Hospitals Birmingham NHS Foundation Trust and local authority budget cuts driven by Local Government Association funding reductions, and legal complexities around Section 75 of the National Health Service Act 2006 agreements.

Regional and Local Variations

Outcomes and delivery varied widely by region: metropolitan areas such as Greater Manchester and London explored devolved and mayoral arrangements linking the initiative to broader devolution deals, while rural counties like Cumbria faced workforce recruitment issues and transport barriers affecting services in community hospitals such as West Cumberland Hospital. Some Integrated Care Systems in Sussex and Northumberland expanded pooled arrangements into wider place‑based commissioning, whereas others retained narrow short‑term interventions. Local diversity reflected differing priorities set by elected authorities (for example, Surrey County Council versus Newcastle City Council), the profile of acute providers, and involvement of voluntary sector partners like Macmillan Cancer Support and Samaritans.

Category:Health policy in England