Joint letter to Rt Hon Jeremy Hunt MP re Better Care Fund


To: Secretary of State for Health

15 September 2017


Dear Jeremy

Re: Better Care Fund 2017-19


Local authorities in the West Midlands are working hard to sustain adult social care, support the NHS and integrate services. We have many examples of good practice, including in supporting timely hospital discharge.


The Better Care Fund (BCF) guidance released in July includes a national target to reduce the number of NHS beds occupied by delayed discharges to 3.5%. We recognise the importance of ensuring that people do not remain in acute hospitals longer than necessary, however we do have some serious concerns about the target.


First of all we are not confident that the data is accurate. We see regular examples in parts of the region where Acute Trusts record delays as attributable to adult social care without following the national guidance. This artificially inflates the figures and gives an erroneous impression of where the barriers to discharge actually lie.


We are also concerned about the disproportionate emphasis placed on delayed transfers of care: we know that Acute Trusts in many areas are failing to hit the 4 hour waiting time target and this is due to issues with internal capacity and operational processes more than issues with the ‘back door’.


Secondly the target was set towards the end of July with a requirement that it be met by September. For many CCGs and local authorities, including over half in the West Midlands, this is simply unachievable. These local authorities have instead submitted trajectories to meet the target over a longer timescale.


NHS England’s position is that those local authorities who cannot meet the target will not have their BCF approved and will therefore not receive the cash transfer from the NHS to protect adult social care. This is funding of around £150 million in the West Midlands that has been transferred to local authorities for the last few years and on which we depend to fund a range of essential services including reablement, home care and residential / nursing care, all of which directly support the NHS.


Without this funding these services cannot be sustained. With winter approaching this will have a catastrophic impact on local people, and will hugely increase pressure on the NHS, leading to a serious crisis. Every pound that is withheld risks harm to our most vulnerable citizens, and will mean that the delayed discharges target will never be achieved. We urge you therefore to provide assurance as a matter of extreme urgency that all local authorities will receive their funding in full.


Finally the way that NHS England has sought to impose unrealistic targets and threatened the withdrawal of funding has damaged relationships and will impede the development of Sustainability and Transformation Partnerships. We want to work with and support the NHS and this sort of behaviour will make it impossible.


Kind regards

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