Reviewing a Better Care Fund Agreement


The Better Care Fund was introduced to help streamline and integrate the delivery of services leading to improved care and reduced costs. But in some areas, these benefits have not been delivered as expected and this has led to disputes between CCGs and local authorities.


In one case, a group of CCGs and a local authority agreed to pursue, jointly, several efficiency programmes that would deliver financial savings. The CCGs 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 CCGs were required to make a direct payment covering part of the shortfall.


The Edge Health team were asked to undertake a forensic review of the BCF agreement, which covered the health and care needs of a population of approximately 1.5 million people. The team analysed how the initial savings had been estimated and assessed whether the approach was appropriate for the local situation. The team then examined how the savings had been translated into operational action and implementation, this included an extensive review of historical documents, data analysis, and a series of structured and unstructured interviews with key individuals.


The Edge Health team concluded that the initial opportunity assessment had been optimistic and that the design and implementation of the schemes were not appropriate given the anticipated level and pace of savings. The Edge Health team 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 CCGs 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.

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