News / BCF preparation and savings plans did not match ambition, NAO says

A report on the BCF, under which clinical commissioning groups and local authorities will pool £5.3bn in 2015/16, said the quality of the initial planning and preparation did not match the scale of ambition.

Planning for the better care fund said the BCF aims to better integrate care, prevent hospital admissions and avoid long stays in hospital. However, to drive change from the bottom up, local areas were left to develop their own plans with minimal central prescription and support, the NAO said. The initial scheme guidance did not mention the scale of savings that were expected from the fund.

Initial plans submitted by the 151 areas expected to save £55m in 2015/16, not the £1bn ministers had planned.

None of the plans were approved at this stage and all areas were asked to resubmit their proposals in September for approval in October – effectively reducing areas’ preparation time from 11 months to five months.

Most plans were approved or approved with support, but they forecast savings of £314m for the NHS (£532m overall), based on a 3.5% reduction in their total emergency admissions over 2014 levels.

But the NAO said that expecting such reductions in one year was ambitious. There is limited evidence that integrated care reduces admissions sustainably, improving outcomes and saving money.

The report said: ‘Acute providers have fixed costs; there is uncertainty over reductions becoming sustainable; and large-scale changes are needed to decommission services. These facts suggest that saving £300m in 2015/16 is ambitious, even if emergency admissions do reduce overall by 3.5%.’ Local areas have proposed reductions of 3.1%, it said.

NAO head Amyas Morse said the BCF was innovative and ministers were right to pause during the summer when it became clear plans would not match their ambitions. But he criticised the early planning.

‘The £1bn financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government’s confidence in the fund’s value,’ he said.

The NHS Confederation backed the NAO’s findings. Policy director Johnny Marshall reiterated concerns about the ability of some local areas to achieve the reductions in levels of emergency activity and the required financial savings.

‘It will take time for the new models of care to allow us safely to disinvest in existing services,’ he said. ‘This is why we will need financial flexibility and extra resources to allow double-running of some services while we move to the new models of integrated care.’