An upgraded Better Care Fund: game changing or game playing?
You’ll have heard few cheers for the Better Care Fund (BCF), the bright idea intended to nudge the NHS and local authorities into each other’s arms – mostly, it should be added, for the benefit of the former. Although it may have set hearts aflutter at the time, it hasn’t actually produced a match made in heaven.
The fragile nature of the relationship has never been better illustrated than in one hospital’s attempt to combat delayed discharges. It mounted a predatory raid on capacity normally contracted by the local authority for ongoing care, securing beds for step-down purposes by the simple expedient of overpaying. Its comeuppance for this aggressive procurement came subsequently when residents were stranded by the resultant reduction in council-funded accommodation for long-term usage.
A failure to consider, let alone consult on, expanding capacity sparked a Wild West competition for existing provision. For providers, a short-term “win”. For the NHS, “bed blocking” wasn’t resolved; it was just moved to another setting.
The question now must be: will this year’s version of the stopgap measure (iBCF) do any better? Health and social care bodies have a well-developed tendency to act unilaterally. A makeshift inducement will be unlikely to persuade them to shed that skin. If they come under pressure, they will do whatever it takes to hit their targets – like taking impromptu action to uncork momentary bottlenecks in the discharge process.
Whitehall expects iBCF to stimulate improved performance on delayed discharges in underachieving areas, with developments being policed by CQC. It takes no leap of imagination to foresee this oversight being seized on by local care home operators to game the system. The ominous presence of the regulator could give them a useful, perhaps a decisive, edge on prices. I very much doubt they’d decline the chance to put the take-it-or-leave-it boot on the other foot.
- The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.