Devon care fund’s first ever overspend nears £2.5 million as targets overshot

The organisation responsible for overseeing the county’s care provision has reported an overspend of nearly £2.5 million before the end of its financial year.

The Better Care Fund (BCF), which was established in 2015, helps create a bridge between health and social care, such as assisting elderly patients to return home after a hospital admission.
A fresh update shows Devon may overshoot its target for emergency hospital admissions due to falls, and that more people are in care homes than it had hoped for, while fewer people than targeted have remained out of hospital for 91 days after admission.
All this is putting pressure on finances, and in a recent update, the fund reported that it had spent nearly £2.5 million more than its £131 million budget at the end of February – a month before its financial year ends.
Solveig Wright, Devon County Council’s deputy director for adult commissioning and health, said the fund had not overspent before.
“This is the first year ever there was an overspend in the Better Care Fund,” she told Devon’s health and wellbeing board, which has oversight of the BCF.
“This is because it is experiencing a lot more demand and we are using the funding in different ways.
“The overspend was known about throughout the year and so there has been no disagreement about it.”
Ms Wright said any overspend by the BCF has to be split 50:50 between Devon County Council and the Devon Integrated Care Board.
In terms of performance, Ms Wright said the county was on track to meet its target of avoidable hospital admissions, even though a problem with community nursing data meant an incomplete picture.
“Even with that anomaly in community nursing, we are doing well at keeping people out of hospital,” Ms Wright added.
And discharges to a person’s normal place of residence were also on track, with 92 per cent of people discharged from acute hospitals to their homes.
Elsewhere, data showed 360 admissions for falls over three-months, slightly above its targeted 354 per quarter, while the county is expected to have more people in care homes than targeted, partly caused by the patchy performance of an assessment service that decides when people can return home.
“We want people to live independently in their own homes without the need for a care home, and if we have the right community services in place, we should be able to hold this relatively stable,” Ms Wright said.
“But we are not on track, and while we have always performed well, the reason I think we are seeing an increase, something we have in common with other authorities, is that there is an unintended consequence of the local discharge to assess process.
“Namely, that we are not assessing people quickly enough, and if people have been in a care home for a few weeks, it is really hard to get them back to their own homes, as they decompensate and family situations change, and so we’re seeing more people convert short-term care home stays to long-term ones.”
Ms Wright said the discharge-to-assess scheme, whereby patients are taken out of hospital to understand their care needs in a setting that more closely resembles their own home, was “absolutely the right thing”, particularly for frail patients or those with dementia.
But she added the BCF would be looking at ways to find beds for discharge-to-assess tailored specifically to be short-term.
Linked to this is Devon’s reablement score, which looks at the number of people still at home 91 days after discharge from hospital into rehabilitation services.
A lower figure suggests success in supporting people to return to full independence.
However, Devon isn’t on track to hit its target, with latest data suggesting only 71 per cent of such people remain out of hospital 91 days after discharge, below the 75 per cent target.