Why integration? Why the BCF? Why now? | Andrew Ridley

older woman and care worker

This week is an important milestone for the Better Care Fund (BCF). Despite a challenging timetable, all BCF plans were submitted as expected by the deadline. The hard work and dedication this has taken is truly impressive; it is a testament to the dedicated staff and joint working that has taken place in every single area. We have five approved fast-track areas, and plans received from everywhere else that show real ambition and determination. These plans are now going through a tested and consistent assurance process.

I have been in direct contact with many areas in the past few months, and am encouraged by the support people have expressed for the principles of the BCF. I also know that, at times, filling out templates and crunching numbers in spreadsheets has been a grinding task! I would like to reflect for a moment on why this exercise has been necessary. 

On a recent visit to Greenwich, I was struck by the story of one of its residents, Tom, a builder, who had severe weight problems for two years and suffered leg ulcers and depression – in other words, he had a number of complex conditions that would often be considered separately. 

By listening to Tom, and treating him as a whole person rather than a separate set of conditions, Greenwich’s coordinated care service helped transform his life. He lost 21 stone, and his wellbeing has improved to the point that he is now looking to go back to his job. 

The staff I met were sold on this person-centred, coordinated approach. One GP told me that he felt “enlightened” by multi-disciplinary meetings with social workers, housing staff, physiotherapists and others, as he could now see how the various non-medical aspects of his patients’ lives were directly affecting their medical conditions.  

Tom isn’t alone: there are thousands of people with multiple conditions, in a system that is not always designed for these kinds of needs. We should celebrate that people are living longer, but with this means a different burden of disease, and the need for new models of care.

Better outcomes for people must always be the primary goal, but the good thing about integrated approaches is that they can save money too. Some will note that the evidence on savings is not conclusive, but the BCF is helping to build this evidence base. Through its BCF plan, Greenwich projects that it will save almost £4 million, and the robust modelling that was required by the BCF process showed that these numbers appear to stack up. 

I know that some areas have plans for integration that are more ambitious than the BCF. I applaud this and encourage such ambition. However, there are many areas only just beginning their journey towards integrated care. The BCF is designed to instigate local discussions and new relationships across organisations that may not have existed before – and these will not always be easy. 

The pooling of £3.8 billion is one of the most ambitious programmes in the history of health and social care, and with this comes inherent risk. It was a leap borne out of necessity because ‘business as usual’ is simply no longer an option. The depth of analysis required in BCF plans may have seemed like a bureaucratic exercise, but it would be irresponsible to embark on such an ambitious programme without the underlying numbers and analysis to back it up. 

The achievement in getting plans agreed locally should not be underestimated. The bigger challenge is making them a reality. The severity of the financial climate presents a real risk to implementation, but having an approved plan means it will be evidence based with strong financial modelling that will give it the best chance of succeeding. Some plans will be approved with conditions, and some may not be approved – we will work with these areas to get the plans to a place where the pooled budget can be spent in a safe and sustainable way. 

A highlight in my time in post has been the collaboration between local areas and the national programme team, and I hope this continues. We really do want to be here to help, and not hinder, local delivery.

It is clear that pooled budgets and integrated care are here to stay, and only likely to become a more prominent part of the health and care landscape. Whether or not you agree with the specifics of the BCF as a mechanism for pooling budgets, the work that has been done marks a real, demonstrable step on the journey we all have ahead of us. It is up to all of us to continue to grasp the opportunity it presents to help make the transformational change that is necessary. 

Andrew Ridley is the programme director for the Better Care Fund Taskforce, which is a joint team comprising NHS England, the Local Government Association, Department of Health and Department for Communities and Local Government. Follow Andrew on Twitter @BCFAndrew.

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