Care closer to home does not happen because two organisations agree it is a good idea. It happens because someone signs a legally binding agreement that pools money, sets out who is accountable for what, and forces an NHS body and a local council to plan services as one system rather than two. In London, that mechanism is the Better Care Fund (BCF), delivered through what is formally known as a Section 75 agreement. It is the least visible part of integration policy and arguably the most load-bearing.
This piece sets out what the Better Care Fund actually is, how a Section 75 pooled budget works between an Integrated Care Board (ICB) and a London borough, and why the mechanics of the agreement matter as much as the funding total attached to it.
What the Better Care Fund Is For
The Better Care Fund is a national programme that requires the NHS and local government to pool a portion of their budgets for health and social care services in every area of England. Its stated purpose is to help people live independently for longer, reduce avoidable hospital admissions, and deliver more joined-up, person-centred care for people with complex needs — the same aims that sit behind "care closer to home" more broadly. The fund began with a national pooled total of £5.3 billion when it was introduced in 2013, and by 2019–2020 the combined mandatory and voluntary contributions pooled nationally had grown to around £9.2 billion.
The BCF is built from three mandatory components, and each does a different job:
- The NHS minimum contribution — a sum each ICB must put into the pool, calculated by a national formula, earmarked for social care services that reduce pressure on the NHS, such as reablement or short-term home care that prevents a hospital readmission.
- The Local Authority Better Care Grant — funding paid to councils that must also go into the pooled arrangement and be spent according to the jointly agreed BCF plan, not spent unilaterally by either partner.
- The Disabled Facilities Grant — capital funding routed through the BCF to councils, used to fund home adaptations such as stairlifts, ramps and level-access showers that keep people safely housed rather than in hospital or residential care.
The Legal Mechanism: What a Section 75 Agreement Actually Does
A Section 75 agreement, made under powers in the NHS Act 2006, is the legal instrument that lets an NHS body and a local authority pool budgets and share functions. Without it, an ICB and a council are two separate accountable organisations, each with its own budget, its own duties, and no lawful way to simply merge spending decisions. The agreement is what converts a shared ambition into a governed, auditable arrangement.
A Section 75 agreement typically sets out four things: the pooled budget itself and how each partner’s contribution is calculated; joint commissioning arrangements, so services are bought once rather than twice; defined responsibilities, spelling out who manages the money, who is accountable for outcomes, and which residents are in scope; and a governance structure — usually reporting into a borough’s Health and Wellbeing Board — that reviews performance and resolves disputes between the two partners.
Table: The Three Building Blocks of a London BCF Plan
| Component | Who provides it | Typical use |
|---|---|---|
| NHS minimum contribution | The local ICB, via national formula | Reablement, home care to avoid readmission |
| Better Care Grant | Central government to the council | Social care services under the joint BCF plan |
| Disabled Facilities Grant | Central government to the council | Home adaptations — ramps, stairlifts, wet rooms |
How This Plays Out Across London’s Boroughs
London does not have one Better Care Fund — it has one per borough, each negotiated separately between that borough’s council and its local ICB. The shape of each plan varies with local priorities, but the legal architecture is identical everywhere. Some London boroughs’ published BCF governance describes the plan’s focus explicitly: proactive support for people with complex needs, shared frailty pathways between hospital and community teams, and early intervention for people with dementia, mental health needs or a learning disability. Others frame their Section 75 partnership as covering discharge support, reablement, home adaptations and services for unpaid carers — the practical glue that keeps a hospital discharge from turning into a readmission a few weeks later.
What is consistent across boroughs is the sequence: a local plan is drawn up jointly by the council and the ICB, agreed through the borough’s Health and Wellbeing Board, and then reviewed regionally before receiving national sign-off. That sequence is why BCF plans read as bureaucratic — they are, deliberately, because the money only moves once both statutory partners and their overseers agree it should.
Why the Mechanism Matters More Than the Headline Number
It is tempting to read the Better Care Fund purely as a funding total, but the more consequential feature is the agreement itself. A pooled budget without joint governance is just two organisations spending near each other. A Section 75 agreement forces a shared decision on where the money goes, who is accountable when it does not work, and how disputes are resolved — which is precisely the structural gap that "Better Health for London" identified when it called for care to be organised around the patient rather than around institutional boundaries. The Better Care Fund is not the whole of integration policy, but it is one of the few parts of it with a legal signature attached.
For residents, the practical effect is invisible by design: a hospital discharge that includes a home adaptation and a short reablement package looks like ordinary good care. It is, in fact, the output of a pooled budget and a Section 75 agreement doing exactly what they were built to do.