Roundtable Context
The BCF combines mandatory contributions from Integrated Care Boards, the Local Authority Better Care Grant, and the Disabled Facilities Grant. In 2025–26, its minimum income stands at £8.97 billion. Additional voluntary contributions totalled £2.7 billion in 2024/25.
There was strong support around the table for the BCF's principles — and a clear sense that where discharge pathways have been properly integrated, the results are significant. One local authority reported that within three months of integrated working:
- · Readmissions were reduced by around 20%
- · Average length of stay for the most complex needs fell from around 57 days to 28
- · 16% of people expected to need long-term placements were instead able to go home
These figures are from a single local authority participant's reported experience at the roundtable — they are not system-wide or independently verified statistics.
Roundtable Attendees
Jen Craft MP— Member, Health and Social Care Committee · Margaret Allen— Deputy Alliance Director, NHS Thurrock Alliance · Charmaine Duce— Deputy Director of Operations, Mid and South Essex ICS · Beverley Flowers— Director of Strategic Planning, Hertfordshire and West Essex ICS · Vena Kaur Bhakar— Head of Finance (Adults and Health), Thurrock Council · Nicola Mickleburgh— Lead Commissioner (Older People), Southend City Council · Robert Persey— Director of Adults and Health, Thurrock Council · Magdalena Piwowarczyk— Integration and Partnership Lead, Essex County Council · Michelle Stapleton— Integrated Care Pathway Director, Mid and South Essex NHS Foundation Trust · Laura Taylor-Green— Executive Director, North East Essex Alliance · Ann Taylor— CEO, Hilton Nursing Partners · Atholl Craigmyle — Finance Director, Hilton Nursing Partners
Key Roundtable Themes
Rethinking Discharge
“We stopped asking whether it was health or social care — it became about getting the person into the right place.”
— Senior ICS representative
Discharge dominated discussion. Bringing funding into a single pot removed arguments over whose responsibility a patient was. MDT working was identified as the real driver of better outcomes — not the funding itself, but teams coming together around shared information about "what we already know about the person". One local authority reported readmissions reduced by around 20% within three months, average length of stay for the most complex needs falling from around 57 days to just 28, and 16% of people expected to need long-term placements going home instead.
Planning Without Certainty
“Funding arrives so close to delivery that you're just keeping a lid on service provision.”
— ICB representative
While there was widespread support for the Fund's principles, many felt it had shifted from a flexible integration vehicle into a holding mechanism for existing services. Short-term funding cycles — returning to one-year for 2025/26 — were the primary concern. Late guidance means money is spent managing winter pressures rather than enabling transformation. Independent providers can only commit in short bursts: "You just maintain the status quo and begin to lose capacity and innovation."
Integration in Practice
“Integration works best when you bring together the people who actually deliver care.”
— Local authority representative
Where integration works well, it was attributed to shared purpose and trust between people — not formal governance structures or pooled budgets. Neighbourhood working was highlighted as a practical way of making integration real, with place-based teams better placed to understand local context: transport, housing, access. Participants warned that without more stable funding, integrated ways of working risk being eroded under operational pressure.
Measuring Outcomes
“The system ends up doing what gets measured, not necessarily what delivers the best outcomes.”
— Local authority official
Too much emphasis on activity and flow; not enough on outcomes that matter to people. Preventative work rarely appears in short-term metrics despite being central to reducing long-term demand. Fragmented digital systems force professionals to rely on proxy measures rather than a rounded understanding of a person's journey — and mean success is defined by discharge rather than recovery or independence. Jen Craft MP challenged the group to consider whether current measures genuinely capture success from a user's perspective.
Prevention Under Pressure
“Prevention is harder to evidence quickly... it's the first thing to be deprioritised.”
— Senior local authority representative
When budgetary pressures come, preventative investment is the first casualty — pushing systems into a reactive cycle. Several participants called for a smaller set of shared outcome measures, focused on people rather than processes: sustained independence, reduced need for ongoing care, avoidance of readmission. One ICB representative argued that if partners were held collectively accountable for such outcomes, "it would change how resources are used and where effort is directed."
Local Collaboration & the BCF
“You just maintain the status quo and begin to lose capacity and innovation — you have to cut back somewhere, and that creates problems.”
— Local authority attendee
Participants broadly agreed the BCF's founding principle — creating a shared space for health and social care funding — remains important. But without clearer purpose, better alignment with planning processes, and measures that reflect what matters to people and communities, short-term objectives will continue to dominate. The overall tone was not pessimistic: there was a shared conviction that with the right changes, the Fund could play a much stronger role.
