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What is the Better Care Fund?
Established in 2015, the BCF requires the NHS and local government to agree shared plans for using pooled budgets to support integration. The fund operates through Section 75 agreements between local authorities and Integrated Care Boards, creating legally binding partnerships for managing pooled resources.
BCF Funding Streams
Mandatory Elements:
- NHS minimum contribution
- Disabled Facilities Grant (DFG)
- Improved Better Care Fund (iBCF)
- Additional adult social care funding
Optional Elements:
- Additional NHS and local authority funding that partners choose to pool
Background and Purpose
The Better Care Fund was established in 2015 as England's flagship integration programme, requiring local authorities and NHS organisations to pool budgets and work collaboratively. These National Objectives evolved from the programme's origins and were refined based on lessons learned about what drives successful health and social care integration.
The Four Objectives are:
- Reform to support the shift from sickness to prevention: Local areas are required to agree plans that help people remain independent for longer and prevent escalation of health and care needs, including timely, proactive, and joined-up support for people with more complex health and care needs.
- Reform to support people living independently and the shift from hospital to home: There is a requirement to agree plans that help prevent avoidable hospital admissions, achieve more timely and effective discharge from acute, community, and mental health hospital settings, supporting people to recover in their own homes (or other usual place of residence).
- Support for unpaid carers: There is a requirement to support unpaid carers.
- Use of home adaptations and technology: There is a requirement to use home adaptations and technology to support people with more complex health and care needs
These four National Objectives were set by NHS England and the Department of Health and Social Care as part of the Better Care Fund (BCF) framework.
Why These Four Objectives?
The objectives reflect several key policy drivers:
System pressures – Aging population, increasing complexity of need, and unsustainable hospital demand required a fundamental shift toward prevention and community-based care.
Evidence from integration pilots – Early integration programmes demonstrated that preventing crises, coordinating care, and reducing duplication delivered better outcomes and value.
Policy alignment – The objectives connect directly to NHS Long Term Plan priorities, the Care Act's wellbeing principle, and successive government commitments to "integration by default."
Financial imperatives – With constrained budgets, the focus on prevention, avoiding admissions, and reducing duplication addressed the need to make every pound work harder.
How Were They Developed?
The objectives emerged through:
- Consultation with local areas that tested different integration approaches
- Analysis of what worked in high-performing health and care systems
- Alignment with existing policy frameworks including NICE guidance on integrated care
- Input from professional bodies like ADASS (Association of Directors of Adult Social Services) and NHS leadership
The framework deliberately kept four objectives to maintain focus while being broad enough to accommodate local flexibility in delivery approaches. Each objective contains implicit metrics (hospital admissions, discharge delays, care experiences) that allowed national monitoring while respecting local autonomy.
Planning Requirements
Each area must submit a BCF plan including:
- Vision for integration and how BCF will support it
- Income and expenditure across different schemes
- Metrics and trajectories showing expected impact
- Evidence of partner agreement and required sign-offs
Key Metrics
- Reducing Unplanned Hospitalisation – Emergency admissions for conditions manageable in community settings.
- Improving Discharge – Percentage of inpatients in hospital between 14-21 days.
- Admissions to Residential Care – Rate of permanent care home admissions, reflecting success in enabling independence.
- Reablement Effectiveness – Proportion of people remaining at home 91 days after discharge and reablement support.
Common BCF Investment Areas
Integrated Urgent Care – Urgent community response teams, crisis services, falls response, and virtual wards.
Hospital Discharge Support – Discharge to assess pathways, intermediate care, reablement services, and enhanced care home support.
Prevention and Early Intervention – Falls prevention, social prescribing, assistive technology, and housing adaptations.
Integrated Care Teams – Multidisciplinary teams bringing together GPs, community nurses, social workers, and therapists.
Care Market Support – Investment in home care capacity, workforce development, and provider sustainability.
Key Challenges
Competing Priorities - NHS organisations face pressure to meet national targets around A&E waiting times and care backlogs, consuming management attention and financial resources that leave little capacity to invest in preventative services that may take years to demonstrate impact.
Different Organisational Cycles -The NHS operates on an April-to-March financial year with late allocations and in-year adjustments, while local authorities must set council tax levels and agree multi-year budget frameworks through public consultation, creating misaligned timelines that make joint commissioning difficult when one organisation is planning in three-year cycles while the other responds to urgent, in-year financial pressures.
Attribution and Measurement - BCF schemes typically invest in preventative interventions designed to avoid hospital admissions, but proving that an admission didn't happen because of an intervention is methodologically complex and requires sophisticated data analysis, creating a "prove it now" culture that disadvantages the upstream, preventative work the BCF is designed to enable.
Workforce and Capacity - Home care workers, occupational therapists, physiotherapists, community nurses, and social workers are all in critically short supply, with vacancy rates in some areas exceeding 10-15%, meaning BCF investments in hospital discharge support or reablement services cannot be delivered at the scale required even when funding is available and partnerships are aligned.
Digital Infrastructure for BCF Success
Shared Care Records – Enabling professionals across health and social care to access relevant information.
Integrated Care Coordination – Case management systems supporting multidisciplinary assessment, coordinated care planning, and outcome tracking.
Performance Analytics – Real-time dashboards tracking metrics, identifying trends, and evidencing impact.
Workflow Management – Automated processes ensuring timely progression across organisational boundaries.
Financial Systems – Tracking pooled budget contributions, scheme spending, and demonstrating outcomes achieved.
How Access Solutions Support BCF
Access Mosaic is a market-leading social care management system used by local authorities across the UK to manage adult and children's social care services. Designed specifically for the complexities of statutory social care, Mosaic provides a single, integrated platform for case management, assessments, care planning, and safeguarding—making it the ideal foundation for integrated health and social care working under the Better Care Fund.
Access Mosaic provides comprehensive case management enabling:
- Multidisciplinary team working with appropriate information sharing
- Tracking people through BCF funded pathways including discharge and reablement
- Outcome monitoring demonstrating impact of integrated services
- Financial management linking individual care to BCF schemes
- Interoperability - APIs connecting with NHS systems, standards-compliant data exchange, and consent management ensuring information governance compliance.
- Analytics - Dashboards providing performance visibility, cohort analysis, predictive analytics, and long-term outcome tracking.
- Workflow Orchestration - Automated workflows ensuring appropriate steps, visibility for all professionals, and escalation when timelines are at risk.
5 Ways to Maximise BCF Impact
These five principles provide a roadmap for partnerships seeking to move beyond compliance and achieve genuine transformation:
- Start with Outcomes – Redesign services around outcomes that matter to people, engaging citizens in defining success.
- Invest in Prevention – Protect preventative investment even under short-term pressure, tracking long-term outcomes.
- Build System Leadership – Develop leaders who think beyond organisational boundaries and prioritise system benefit.
- Use Data Intelligently – Share data across partners, analyse what works, involve frontline teams, and maintain transparency.
- Enable Frontline Integration – Ensure practitioners understand BCF, remove barriers to integrated working, and recognise collaborative practice.
Moving Forward
The Better Care Fund stands as one of the most ambitious policy mechanisms for dismantling traditional barriers between health and social care in England, yet its transformative potential remains largely unrealised without fundamental shifts in how local systems operate, substantial investment in shared data architectures and interoperable technology platforms, and leadership willing to move beyond organisational self-interest towards genuine system-level accountability.
Success ultimately requires sustained political and executive resolve that maintains strategic focus across electoral cycles and organisational restructures, ensuring BCF initiatives genuinely challenge organisational boundaries rather than protect them in favour of coordinated care that serves vulnerable populations.
