Maximising the Impact of the
Better Care Fund

Roundtable Attendees

Helen Maguire MP, Lib Dem Spokesperson for Primary Care and Cancer  · Jodie Adkin, Deputy Director, Urgent & Emergency Care Improvement and Delivery, South East London ICB (Bromley) & Bromley Council  · Paul Connolly, Head of Integrated Contracts and Performance, Croydon Council  · Atholl Craigmyle, CFO, Hilton Nursing Partners  · Jeremy DeSouza, Executive Director of Adult Social Care and Public Health, Richmond & Wandsworth Councils  · Claire Edgar, Executive Director for Adults, Wellbeing and Health Partnerships, Surrey County Council  · Jack Howell, UEC and Better Care Fund Lead, Lewisham Council  · India Multani, Strategic Director of Integrated Care, St George's, Epsom & St Helier  ·  Sally Reed, Joint Commissioning Manager, East Sussex County Council  · Brian Roberts, Head of Health and Care Integration, Richmond & Wandsworth  · Darren Summers, Strategic Director of Health and Care & Southwark Place Executive Lead, Southwark Council and South East London ICB  · Ann Taylor, CEO, Hilton Nursing Partners  · William Walter, Managing Director, Bridgehead Communications  · Lucie Waters, Director of Integration, South West London ICB  · Jane Williams, Director of Integrated Delivery, Surrey Heartlands ICB

BCF Purpose & Clarity

“Honestly, I'm not sure I could say, hand on heart, what the Better Care Fund is currently meant to achieve.”

Source: Local authority/ICB attendee

The roundtable opened with a shared concern that the Fund's original intent has become obscured. Participants valued its founding principles but many felt it had drifted from an effective, agile vehicle for integration into a bureaucratic process stuck in a rigid framework that limits innovation. The ask: the BCF should be an enabler, not an end in itself.

Planning & Guidance

“A one-year pilot is meaningless. You can't show value for money or cost avoidance in that time.”

Source: Roundtable participant

Rushed six-week planning windows and late guidance make commissioning transformative services structurally impossible: one authority said winter planning alone takes 100-150 hours. An attempt at a two-year plan was undermined when a “massive review” was added partway through, and the timetable reverted to one-year in 2025-26. An independent provider said being told in October to deliver in January, then stop in March, “cannot work”.

Metrics & Evaluation

“We know everything about ophthalmology or dialysis, but so little about the impact of health on social care in the community.”

Source: ICB representative

Metrics are fixated on small, tactical discharge numbers rather than transformative change. The current data reporting framework is seen as too narrow and bureaucratic, valuing what can be easily counted, acute and discharge activity, over outcomes, prevention and population health. Participants said vast data exists on acute care but almost none on how health interventions shape social care outcomes in the community.

Integration in Practice

“The Better Care Fund has, in some cases, become a battleground between health and social care.”

Source: Local authority attendee

Health and social care were likened to “oil and water”: a nationally funded, free health service against a locally funded, means-tested care system. Ring-fencing and rigidity around the BCF were said to have caused disputes between organisations. Attendees also raised a lack of meaningful national engagement: “We get zero engagement nationally… we send them all this data and never see anything back.”

Housing & the Disabled Facilities Grant

“It's so restrictive on what you can spend it on and how you can use it.”

Source: Local authority participant

Housing needs to be woven into BCF planning from the outset: “No health without housing,” as one ICB lead put it, since timely home adaptations can prevent hospital admission and reduce the need for long-term care. Views on the Disabled Facilities Grant were split: some found it too restrictive on what it can be spent on, while others saw scope within its rules for more flexible local plans.

Innovation & the Future

“It should be on creating a framework with long-term commitment, clear vision, ambition, and local flexibility to do what works for residents and actually makes a difference.”

Source: Local authority integration lead

Participants argued the focus should shift from redesigning BCF templates toward a framework with long-term commitment, clear vision and local flexibility. One ICB representative said the future of innovation depends on trust and shared accountability, floating neighbourhood health as the integration vehicle that could subsume the BCF itself.

BCF purpose has become obscured: Participants across Surrey, Sussex, and South London said they couldn’t say “hand on heart” what the Fund is currently meant to achieve.

Short planning windows: Planning windows as short as six weeks in practice make it impossible to commission transformative services; one-year pilots are “meaningless”.

Metrics fixated on discharge: At the expense of understanding how health interventions shape social care outcomes in the community.

Housing must be woven in: Timely home adaptations prevent admission, but the DFG's restrictive scope limits innovation.

Neighbourhood health as the next chapter: Anchoring BCF investment in communities with long-term commitment and local flexibility.