Pressure on hospital beds 'not improved by extra money'

Government plans to treat more patients in the community are not easing pressure on NHS hospitals or saving money, says the National Audit Office.

It looked at progress in England following the introduction of a £5.3bn Better Care Fund to help local authorities invest in services to keep patients out of hospital.

It says in its first year, the fund has helped join up health and social care.

But it hasn’t led to the expected reduction in hospital workload.

The Department of Health said it was too soon to judge the Fund’s impact.

Iris Sibley’s six-month wait to leave hospital

According to the NAO, within the first year of the Better Care Fund being introduced:

  • The number of emergency hospital admissions has gone up, not down.
  • The number of people stuck in hospital because they have no suitable care package available to them in the community – be that a place in a care home or adequate homecare – has also risen.

The total Better Care Fund budget for 2015-16 was £5.3bn (some local authorities added extra money to the £3.8bn earmarked by the government).

It was hoped the fund would return a saving of around £500m in its first year by reducing demand for costly hospital care.

Using the Fund, local authorities had estimated they could cut emergency hospital admissions by 106,000. Instead, they went up by 87,000, compared to the previous year.

The number of delayed transfers of care cases – when a patient is healthy enough to leave the hospital but is unable to do so – was meant to drop by 293,000. It went up by 185,000.

The NAO report says cash flow worries are mounting in both health and social care and it remains unclear whether more integration of services will help.

It says the government should take stock and evaluate how best to move forward.

The Department of Health says it wants to make care even more joined-up.

‘Slipping into crisis’

Sir Amyas Morse, head of the National Audit Office, said: “Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, benefits have fallen far short of plans, despite much effort.”

Its director, Ashley McDougall, said it could take years to see results from integration and suggested expectations should be lowered around the effectiveness of integration to move people out of hospital more quickly.

He told BBC Radio Four’s Today programme that it was not a waste of money but funding might be better spent elsewhere.

A spokesman for NHS England said: “Joining up local NHS and council services may be worthwhile, but is not by itself a silver-bullet solution to wider pressures on health and social care.”

Prof Jane Dacre, president of the Royal College of Physicians, said: “We should not take the slow progress so far as a signal to stop or reorganise the initiatives – it takes time to transform services and evaluate them to show benefit, so they should be allowed to continue, but with much more involvement from local authorities upfront in planning and implementation, and a funding boost for social care.”

James Taylor from the charity Scope said: “Over 400,000 working-age, disabled people rely on social care, but a chronic lack of funding has left many completely isolated, cut off from society, slipping into crisis and ending up in A&E.

“The government’s ambition to create a country that works for everyone cannot be one that leaves thousands of disabled people without the basic level of support they need to live an independent life.”


A week of coverage by BBC News examining the state of the NHS across the UK as it comes under intense pressure during its busiest time of the year.

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