Maximising the Impact of the
Better Care Fund

Roundtable Attendees

Helen Maguire MP— Lib Dem Spokesperson for Primary Care and Cancer  · Thirza Satwell— Managing Director for Integrated Care, Epsom & St Helier University Hospitals NHS Trust  · India Multani— Strategic Director of Integrated Care, St George's, Epsom & St Helier  ·  Claire Edgar— Executive Director of Adults Wellbeing, Surrey County Council  · Jo Cogswell— Director of Strategy & Joint Transformation, Surrey Heartlands ICB  · Lucie Waters— Director of Integration, South West London ICB  · Brian Roberts— Head of Health and Care Integration, Richmond & Wandsworth  · Jack Howell— UEC and Better Care Fund Lead, Lewisham Council  · Sally Reed— Joint Commissioning Manager, East Sussex County Council  · Ann Taylor— CEO, Hilton Nursing Partners  · Atholl Craigmyle — CFO, Hilton Nursing Partners

BCF Purpose & Clarity

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

— 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 simply can't show value for money in that time.”

— Roundtable participant

Rushed six-week planning windows and late guidance make commissioning transformative services structurally impossible. The reliance on one-year cycles — despite a more welcome two-year period between 2023 and 2025 — was described as the primary barrier to long-term planning and preventative investment. Providers can only commit in short bursts, limiting their ability to recruit, invest and scale.

Metrics & Evaluation

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

— Roundtable participant

Metrics are fixated on small, tactical discharge numbers rather than transformation. Performance frameworks prioritise speed and throughput, shaping system behaviour even when they don't align with longer-term goals. Fragmented digital systems reinforce the problem: professionals are forced to rely on proxy measures when information is held in separate, non-interoperable systems.

Integration in Practice

“The BCF has in some cases become a battleground between health and social care.”

— Roundtable participant

The disconnection between health and social care systems was described as the real underlying challenge. Where integration does work, it was attributed to individual relationships and local leadership rather than systemic embedding. Without more stable funding and clearer alignment between organisations, integrated working risks being eroded under pressure.

Housing & the Disabled Facilities Grant

“Timely home adaptations can prevent hospital admission — but the DFG is too restrictive to enable innovation.”

— Roundtable participant

Housing needs to be woven into BCF planning from the outset. The Disabled Facilities Grant was seen as too narrowly defined to support the kind of early, preventative home adaptation that keeps people out of hospital. Helen Maguire MP highlighted the importance of infrastructure that reflects how people navigate public services day-to-day.

Innovation & the Future

“We need a framework with long-term commitment, clear vision, and local flexibility to do what works for residents.”

— Roundtable participant

Participants argued the BCF should be aligned with neighbourhood health and care models — trusting local experts to build what meets the needs of their population, rather than having decision-making taken out of the hands of those who know their communities. National priorities and guardrails are necessary, but delivery must remain local.

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 — As few 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.