NERA’s Role in a Better Care Fund Review

The Situation

When patients require both health and social care services, coordinated delivery of those services can be difficult to align. The services are funded through different channels, with different incentives and eligibility criteria. The Better Care Fund (BCF) was introduced to help streamline and integrate delivery of services leading to improved care and reduced costs. But in many areas, these benefits have not been delivered as expected and this has led to disputes between health commissioners and local authorities that commission social care.

In one case, NERA was asked to review an agreement between health care commissioners and a local authority. They agreed to pursue, jointly, several efficiency programmes that would deliver financial savings. The health care commissioners also agreed to underwrite the delivery of the savings to give the local authority some financial certainty. However, the majority of the planned efficiency savings failed to materialise, and the health care commissioners were required to make a direct payment covering part of the shortfall.

NERA's Role

NERA undertook a forensic review of the BCF for an area of England that covered the health and care needs of a population of approximately 1.5 million people. The NERA team analysed how the initial savings had been estimated and assessed whether the approach was appropriate for the local situation. We then examined how the savings had been translated into operational action and implementation. To do this, the NERA team undertook an extensive review of historical documents, our own analysis, and a series of structured and unstructured interviews with key individuals.

The Result

NERA concluded that the initial opportunity assessment had been optimistic and that the design and implementation of the schemes was not appropriate given the anticipated level and pace of savings. This was a delicate situation as all parties recognised the need to continue to work together in the future to meet the needs of their local population. NERA took great care to work with parties to reach a common understanding of what could be learned to support the design and implementation of future programmes. The review was well received by both the health commissioner and also the local authority. As a result of the work, the organisations engaged in a constructive dialogue on their future joint working arrangements around the BCF.