How wonderful

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.

As I understand it the aim was to integrate parts of medical care and social care. Thus expensive hospital beds could be replaced by much cheaper care at home. Just the sort of thing that all the lefties are screaming about concerning the NHS itself. You know, integrated cooperation across the whole service rather than the balkanisation of markets.

So, what’s the matter with it?

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.”

It appears that we have difficulties in actually identifying any manner in which such integration actually saves anything.

Which does, rather, pose a problem for the idea that the integrated NHS is better than the balkanisation of markets, doesn’t it?

9 thoughts on “How wonderful”

  1. I find the most extraordinary thing here is that the government examined a planned expenditure, decided it didn’t represent value for money or an acceptable return on investment, and then didn’t go ahead with the spending anyway. Astonishing.

  2. So Much For Subtlety

    It appears that we have difficulties in actually identifying any manner in which such integration actually saves anything.

    I am with Dave above. But the main advantage of these schemes is being ignored – you need to bring in a whole new layer of senior management, all getting six figures, to co-ordinate it all.

    Why else do you think the managers push for it so often?

  3. Well of course there wouldn’t be a saving, because the demand for NHS services is so large (it being ‘free’ and all) that if you spend Xbn shifting the oldies into care in their own homes, you free up space and resources in hospitals, which they will promptly use to fulfill the remaining excess demand for services. So you end up spending the Xbn on the oldies, plus what you would have spent on them in hospital, only on someone else. More gets done, to be fair, but it costs more money, which if you’re actually trying to reduce overall headline costs isn’t much good.

    Unless one gets to a point where the NHS has no excess demand for services, schemes such as this will never generate any savings.

  4. The problem lies in the expectation that, to achieve the aims of the product, money (a lot of money) needs to shift from hospital acute care into social care. And the NHS hates – really hates – this because that means the money goes outside its control and into local councils. Worse still for the lefties who dominate the health bureaucracy, much of the social care provision needed to make Better Care work is provided by private, for-profit businesses.

  5. An elderly relative spent unnecessary weeks in hospital, waiting for social services to sign off on care home costs which they were undoubtedly responsible for. So perhaps there is a problem with conflict between the two budgets.

    I’m not surprised by the conclusion that creating a third budget to fight over would not improve the situation.

  6. Churm Rincewind

    Paul B’s example is germane. For years the NHS and local councils have been at loggerheads as to who foots the bill. For example: Mr X has dementia and needs care. Is this a medical responsibility (NHS) or a social responsibility (local council)?

    There’s no ready answer. Booting such cases out of the NHS would certainly save it money, but only on the basis that the same costs would arise elsewhere.

  7. The answer is more people helping their olds, and more women having children in marriages so that when they grow old husband and wife care for each other, or the children do.

    Not a panacea, but it would help.

    But then, for progressives like Paul, the family was the enemy so it was effectively destroyed.

    Hope you live long enough to be ‘cared for’ by agency staff, Paul.


  8. I’ve got nothing against the family, and I’ve given you no reason to think otherwise.

    I hope you live long enough to stop spewing bile and start dealing with the world as it actually is.

  9. Interested – how do you suggest I look after my elderly disabled parents when they are 125 miles away, I don’t drive and I cannot lift either of them? Cannot even pull them up from a chair.
    They cannot do everything for each other. Its a nice fantasy that families can and will be able to care for parents or the two parents care for each other but reality is often something different. Old person not necessarily capable of caring for old person, adult children not necessarily being able or close enough to care for parents.

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