Maximising the impact of
the Better Care Fund
in North London

Funding & Budget Cycles

“Funding arrives so close to the time you need it that you're just keeping a lid on service provision.”

— Local authority BCF lead

One-year funding cycles were repeatedly identified as a barrier to improvement — making it "very difficult to plan effectively". The two-year cycle used between 2023 and 2025 was "welcome" but the return to one-year for 2025/26 reintroduced uncertainty. Late guidance compounds the problem: BCF money ends up spent temporarily in winter "because you can't set everything up in advance".

ICB–Local Authority Collaboration

“Some aspects of integration had worked really well — but in others it feels like the ICB is marking our homework with a different agenda we don't understand.”

— Local authority BCF lead

Relationships between ICBs and local authorities were described as mixed. Independent providers were often left without a clear picture of how integration works in practice. The absence of shared understanding was seen as having negative ramifications for BCF delivery on the ground.

Patient Experience

“What matters most is the patient journey. Are we ensuring people are cared for in the right place at the right time, with dignity? That should be at the heart of the system.”

— Roundtable attendee — to wide agreement

Participants questioned whether the BCF's reporting and metric frameworks were appropriately centred on individual patient experience. Too much emphasis on numbers — "how many people did you put in?" — was seen as crowding out questions about whether pathways were the right thing for the individuals concerned.

Investing in Prevention

“There's now a real opportunity to revisit the BCF, and have it focus on admission avoidance and prevention. It shouldn't just be seen as a way to manage persistent problems.”

— Local authority lead

Now the NHS 10 Year Plan is published, participants argued for realigning the BCF with its ambitions: shifting from hospital to community, and from sickness to prevention. Neighbourhood working was proposed as a practical vehicle — "if neighbourhood working is the driver for integrated care, how can the BCF support and enable that?" Prevention funding was described as perpetually vulnerable: "Unless there's a clear ringfence, prevention spending will always be eroded by short-term pressures."

Digital Opportunities

“Everyday consumer tech is underused in care. Things like Ring doorbells or smartwatches that prompt movement are low-cost, familiar tools that really help people remain independent.”

— Roundtable participant

Significant "untapped" potential in technology was highlighted — from non-intrusive monitoring equipment (tracking kettle use, sleep patterns) to simple digital access codes for carers and virtual wards. Sojan Joseph MP noted that virtual wards in his local area are "proving highly effective in keeping people safe in their own homes".

Home to Decide

“We want the system to give people time and space to make the right decision — not just the fastest one. Innovation in care can deliver better outcomes without added cost.”

— Home to Decide participant, Hilton Nursing Partners

Hilton Nursing Partners shared their Home to Decide model: up to 14 days of intensive at-home support following hospital assessment, beginning at 24/7 care and stepping down. In one local authority partnership, 65% of people were able to remain at home. In an NHS Trust pilot, every participant was judged safe to stay at home. The model matches the cost of a hospital bed for the period of service.