Whitehall calls halt on £3.8bn NHS reforms

£3.8bn NHS "Better Care Fund" policy delayed after damning Whitehall review

A patient being taken to an operating theatre in a hospital
The Better Care Fund was meant to reduce the growing pressures on hospitals and keep people healthier in their own homes. Photograph: Christopher Furlong/Getty Images

A government policy intended to stop the NHS from becoming overwhelmed has been delayed after a confidential Whitehall review concluded it would not work as hoped. Neither would it help to balance the NHS budget or bring about an intended revolution in patient care.

The £3.8bn-a-year Better Care Fund was supposed to have been launched last week, but its introduction has become mired in doubt after the Cabinet Office voiced deep disquiet about its viability and argued that there was little or no detail about how the expected savings would be delivered.

A Whitehall source said the Cabinet Office believed that the claims for the Better Care Fund did not stack up and wanted "a lot more work done on the policy".

The idea behind the plan, due to be introduced in April next year, was to bring together health and social care services – traditionally funded by local authorities – in the belief that this would reduce the growing pressures on hospitals and help keep people healthier in their own homes.

The delay in its launch is a setback for the health secretary, Jeremy Hunt, and local government secretary Eric Pickles, who were supporters of the plan and had been due to attend its launch last Wednesday.

The Better Care Fund is partly funded by the Department of Health, which was to have contributed £1.9bn from the £40bn hospital budget from next April in the belief that it would release savings to compensate for the money transferred from the NHS.

However, the Guardian has learned that the Cabinet Office review found that plans to save money from local hospital budgets by moving care elsewhere lacked financial credibility, with little or no detail about how savings would be delivered.

Now a team of officials from both departments responsible for the new policy have been told to produce extra evidence to make it more "credible" and overcome deep Cabinet Office scepticism.

Starting in April 2015 in England, the initiative was meant to cut both overcrowding in A&E units and the number of people admitted for hospital treatment. Half of the £3.8bn annual budget would come from the NHS, with all of the money going into schemes that see health and social care services working together in a major step towards the goal of integration.

Projects would help keep frail, older people and those with long-term conditions such as diabetes and breathing problems healthier in their own homes and avoid expensive, unnecessary stays in hospital. Ministers described the new approach as vital to keep the NHS sustainable.

The Cabinet Office also voiced concern that hospitals have been consulted far too little about the plans, while local councils and the GP-led NHS clinical commissioning groups have drawn up local plans.

A Whitehall source familiar with the situation said: "The Better Care Fund is based on the idea that if you invest to build up services outside of hospitals based on integrated care, that will help you to ultimately save money from the hospital budget. But the plans produced so far don't show in detail where savings will be achieved as a result of the investment, or that hospitals will be able to reduce their spending.

"Because they don't, the Cabinet Office don't think the plans produced so far are credible enough and don't have enough information in them about how the savings will be made, or detailed enough forecasts."

Launching a report last week by the King's Fund health think-tank which argued that the NHS was on the brink of a major financial crisis, its chief executive, Prof Chris Ham, criticised the Better Care Fund, as currently envisaged, as "completely unrealistic".

Ham, a member of David Cameron's short-lived group of NHS advisers, said hospital budgets could only be reduced if much more care was already being provided by GPs, community nurses and staff who support patients in their own homes. But "the difficulty is that under the government's plans all of this has to be done in time for plans and budgets to be agreed for 2015-16. This is completely unrealistic".

Taking the £1.9bn away from hospitals "will put additional stress on an NHS already struggling to balance the books and maintain acceptable standards of patient care," Ham said.

Sir David Nicholson, the NHS chief executive when the fund was first announced last year, had described the pooled £3.8bn budget as "a game-changer" for the way patients would receive care, but warned that it involved a potential "financial cliff edge" for hospitals.

Many senior NHS figures fear that the money will be used by local councils to help alleviate the deep cuts they have seen to their budgets under the coalition. Prof Sir Bruce Keogh, NHS England's medical director, has admitted that there is "great scepticism" in the NHS that it will fund the sort of projects intended and "fear that the labels will be taken off the money and that it will be used for filling in potholes and other significant things".

Last week, Bill Shields, the chief financial officer at Imperial College Healthcare NHS trust in London, one of the largest NHS hospital groups, said: "The cynic in me says that this is a way of taking money from the NHS and passing it on to the local authority vote. The expectation is that this will allow them to make good the cliff edge they've been through in the last few years and rebuild the local government public finances." It would also mean "in effect a significant real-terms reduction in NHS income … going forward", he said.

The Department of Health's own guidance on who should receive the £1.1bn it is putting into social care this year, including £200m for the Better Care Fund, appears to confirm that it is in effect shifting money from the NHS straight to local councils. The guidance, published on its website, says that projects eligible for a share include those which "would be reduced due to budget pressures in local authorities without this investment".

A Conservative health spokesman said: "This government is finally doing what the last government talked about but never delivered: joining up the health and social care systems. The Better Care plans start from April 2015 but we asked for early versions to be completed a year early so we could check their level of ambition and deliverability, which is what is happening."

Andy Burnham, the shadow health secretary, said: "Under this government, health policy seems to lurch from one shambles to another. This is further evidence that you can't trust the Tories with the NHS. After a botched £3bn re-organisation, the NHS simply could not afford to rush ahead with these back-of-the-envelope plans.

"This was a panicked response to Labour's plans for full integration. It was never properly thought through and was set on a dangerous and unrealistic timetable. This news will only deepen confusion in the NHS about government policy. It is suffering from a real lack of leadership when it desperately needs a clear direction at a time of tight finances. David Cameron and Jeremy Hunt must urgently clarify the status of the Better Care Fund."

Richard Hawkes, chief executive of the disability charity Scope, said: "Ministers have built up the Better Care Fund as the answer to the care crisis … Chronic underfunding and year-on-year rationing of care have left the system on its knees. Earmarking NHS cash for care was a bold move to stimulate innovative ways of working.

"But for the Better Care Fund to live up to the billing, we need to see a commitment to serious, ongoing investment and a strong focus on preventing people becoming isolated and slipping into crisis. The government's flagship care bill could make a real difference. But the reforms are at real risk."

Fears over plans to cut emergency admissions

Patients' groups have raised fears that hospitals will be forced to cut services before it is safe to do so.

Patients' groups have raised fears that hospitals will be forced to cut services before it is safe to do so
Health watchdogs have warned that pressures on hospitals are “out of control” with a steep rise in the numbers turning to Accident & Emergency departments Photo: Getty Images

Lives could be put at risk by NHS plans to slash the number of people admitted to hospital as an emergency, patients groups have warned.

Health officials have ordered hospitals to scale back admissions to levels not seen for a decade, as almost £2bn is diverted from their budgets to fund community and social services.

Ministers say the changes are needed so that more patients, especially the frail elderly, get help earlier, meaning fewer end up being admitted to hospital.

But patients groups say the rapid timescale planned means overstretched hospitals will have to cut back their services before safe alternatives are in place.

Health watchdogs have already warned that pressures on hospitals are “out of control” with a steep rise in the numbers turning to Accident & Emergency departments.

Plans drawn up by NHS England say hospitals will need to cut emergency admissions by 15 per cent within two years - which means reducing activity levels to those of 2004, when 780,000 fewer patients a year were admitted.

Katherine Murphy, chief executive of the Patients Association, said she was concerned that the target would mean hospital patients being denied care, without alternatives being put in place.

“Reversing demand back to 2004 within two years is unrealistic and impractical,” she said. “We do not have the services in the community to safely care for patients. We are concerned that this initiative will take time to implement and any fast tracking to save money will have an adverse impact on the care and treatment provided to patients.”

NHS managers said privately that the scale of change would be “impossible to achieve” without compromising safety.

A poll of hospital managers by think tank the Kings Fund found that none thought their organisation would achieve the reduction in admissions.

Prof John Appleby, the think tank’s chief economist, said: “It’s not realistic or feasible. We just asked exactly this question in a poll of 42 finance directors working in acute trusts and not a single one thought it could be done.”

He said hospitals would try to find other ways, which could include job cuts, to save the £1.9bn a year which is being transferred from the NHS to a “Better Care” budget for community services.

Prof Appleby said: “Hospitals will look at how to reduce their costs, which probably means employing fewer staff, because that is the biggest cost in their budgets.”

Tomorrow Simon Stevens, the new chief executive of the NHS is due to be questioned by the Commons health select committee, when MPs expected to raise the matter.

Sarah Wollaston, a Conservative member of the committee, said: “We really can’t slash the hospital budgets without puttting the investment into the community first, especially when we know that hospitals are under such great pressure. We will want a clear message from Mr Stevens about how this is going to be handled.”

Earlier this month a report disclosed that Britain has fewer hospital beds than almost any country in the Western world.

A study by the Organisation for Economic Co-operation and Development found that among 23 European countries, the UK has the second lowest number of hospital beds per capita.

Separate figures show that hospitals have repeatedly breached recommended safe occupancy limits.

Jeremy Hunt, the Health Secretary said yesterday that the future of the NHS relies on improving the quality of out-of-hospital care, and that it was a “false economy” to deny investment to community services.

He said: “ The big reform that we need in the NHS, if it’s going to be sustainable in coming years, is to transform out-of-hospital care .. if we don’t help to keep people healthy and happy while they’re at home, they’re going to end up in hospital and that’s going to cost us even more money,” he said.

Chris Hopson, chief executive of the Foundation Trust Network, which represents NHS hospitals, said hospitals supported the idea behind the plans, but had some concerns about the timetable.

He said: “To roll back 10 years of emergency activity this quickly is a stretching challenge - last winter, despite the mildest weather for a century, emergency admissions rose by three per cent.




Plans to shut NHS hospitals could trigger a wave of A&E closures

  • Under the proposals, billions of pounds are to be diverted from hospital budgets to help pay for better care homes 
  • There are fears that the plans could lead to the closure of medical wards 
  • Since 2007, eight English A&Es have been closed
  • Ministers are due to approve the ward closures by April 21


Controversial plans to shut NHS hospital wards across the country – which could trigger a fresh wave of A&E closures – are quietly being drawn up by health bosses, The Mail on Sunday can reveal.

Billions of pounds will be diverted from hospital budgets to help pay for better care homes and home help under the proposals, which are set to be signed off by Ministers within weeks.

But according to official plans seen by this paper, it will force the imminent closure of emergency medical wards, surgical wards and dementia wards.

Frontline doctors also fear the massive shake-up will cause more A&E departments to close – at a time of rapidly rising demand for emergency care.

Since 2007, eight English A&Es have been closed or downgraded. Another 14 are known to be under threat and last year there were a record 3.8million emergency admissions.

The £3.8billion Better Care Fund is meant to ensure that the sick and elderly only end up in hospital when they really need to be there and stop them staying in a ward for longer than necessary



But NHS England calculations have shown that the scheme will ‘transfer’ at least £2billion a year from the health service budget. 

Ministers are due to approve the ward closures by April 21. One leading A&E doctor warned last night that the plans would ‘break the system’, leaving emergency patients without beds.

Dr Chidi Ejimofo said handing so much NHS money to social care was ‘like robbing Peter to pay Paul’, adding: ‘I think there’s every chance this could lead to a new wave of A&E closures.’

Elderly: Under the proposals, billions of pounds will be diverted from hospital budgets to pay for care homes

The consultant, who last year helped save A&E at Lewisham Hospital in South-East London from the axe, went on to say: ‘These plans are extremely worrying given that hospitals are already in a precarious state. We are on the edge of an unmitigated disaster.’

The Government has tried to deny that the Better Care Fund amounts to an NHS cut – and continues to insist it has no policy of shutting A&Es.

But NHS England has claimed that the fund will lead to a 15 per cent drop in emergency admissions after it kicks in next April, and GP-led clinical commissioning groups, which deliver services, have been asked to model ‘savings’ in their budget accordingly.

They have been told to ‘clearly identify where the NHS savings will be realised’ – and will have to show where they could each make an estimated £16million worth of cuts.

Organisations bidding for the fund’s cash are also required to state how they think hospital services will have been ‘reconfigured’ in five years’ time.

An NHS England PowerPoint presentation reminds the applicants of the need to convince staff and the public about the benefits of ‘major service changes as a result of five-year strategy plans and the Better Care Fund’.

But critics have warned that the money will simply disappear into council budgets.

Doctors have also claimed that its aims – while ‘laudable’ – are wildly optimistic.

Labour health spokesman Jamie Reed said: ‘David Cameron promised not to cut the NHS, but he is now raiding it to fill the holes his £2billion cuts have left in social care.’

But Care Minister Norman Lamb insisted: ‘This is not about “cuts” or taking money away from hospitals – it is about providing better joined-up care closer to home. The Better Care Fund is a major step to making this a reality.’

Read more: http://www.dailymail.co.uk/news/article-2603385/Plan-shut-hospital-wards-threatens-new-wave-A-E-closures-break-system.html#ixzz2yqzIywty 
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