Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Clinical Commissioning Group (CCG), the Local Safeguarding Board for Children and Adults and Healthwatch.

 

 

Title: Better Care Fund (BCF) 2022/23 Annual Plan Submissions

 

Date of Meeting: 08 November 2022

 

 

Report of: Robert Persey Director of Adult Social Care, BHCC and Ashley Scarff Deputy Managing Director, NHS Sussex Brighton & Hove & East Sussex

 

Contact:  Andy Witham, Assistant Director, Commissioning & Partnerships

 

 

 

Email: andy.witham@brighton-hove.gov.uk

 

 

Wards Affected:

 

All

 

FOR GENERAL RELEASE

 

Executive Summary

 

This report provides an overview of the Brighton and Hove 2022/23 Better Care Fund (BCF) planning submission.

 

The BCF plan for Brighton & Hove is a jointly agreed plan between local health and social care commissioners and is in line with the approach agreed by the local Health and Wellbeing Board (HWB) in March 2022. The plan for the current year has now been submitted on that basis.

 

The plan, including a narrative plan, is drawn from the Brighton & Hove Place-Based Health and Wellbeing Strategy and existing placed-based plans. The plan provides details of the key strategic place-based partnerships in addition to the HWB, that oversee and govern the development and delivery of the BCF; they include the relevant place statutory providers and commissioners. The planning submission for the year was complete and compliant with all national conditions and metrics and met the national 26 September 2022 submission deadline.

1.           Decisions, recommendations and any options

 

1.1         The Board is recommended to note the requirements for 2022/23 Better Care Funds

1.2         The Board is recommended to note the place-based governance and oversight of developing plans for 2022/23

1.3         The Board is recommended to ratify the submission of the Better Care Fund planning returns for Brighton & Hove for 2022/23 to NHSE in accordance with national requirements and agreed approach submitted on 27 September 2022.

 

 

2.      Relevant information

 

2.1       The Better Care Fund (BCF) is a programme spanning both the NHS and local government which seeks to join-up health and care services, so that people can manage their own health and well-being and live independently in their communities for as long as possible.

 

2.2       The Better Care Fund (BCF) has been one of the government’s national vehicles for driving health and social care integration since 2013. It required Clinical Commissioning Groups (CCGs) and now Integrated Care Boards (ICBs) and Local Government to agree a joint plan, owned by the Health and Wellbeing Board (HWB). These are joint plans for using pooled budgets to support integration, governed by an agreement under section 75 of the NHS Act (2006).

2.3       The Better Care Fund (BCF) has provided a mechanism for joint health, housing and social care planning and commissioning, focusing on personalised, integrated approaches to health and care that support people to remain independent at home or to return to independence after an episode in hospital. It brings together ring-fenced budgets from ICB allocations, and funding paid directly to Local Government, including the Disabled Facilities Grant (DFG) and the improved Better Care Fund (iBCF).

2.4       The continuation of national conditions and requirements of the BCF in recent years has provided opportunities for health and care partners to build on their plans to embed joint working and integrated care further. This includes working collaboratively to bring together funding streams and maximise the impact on outcomes for communities whilst sustaining vital community provision.

 

 

2.5      The local HWB area has produced a narrative plan (Appendix 1).  These draw directly from current place-based plans and read across to operating plans. The submission demonstrates how the schemes that have been invested in, meet the following three national policy areas: 

·      Approach to Integration

·      Supporting Discharge 

·      Equality and Health Inequalities

 

2.6      The BCF plan submission is consists of:

·         A narrative plan

·         A completed BCF planning template, including:

o   Planned expenditure from BCF sources

o   Confirmation that national conditions of the fund are met, as well as specific conditions attached to individual funding streams

o   Ambitions and plans for performance against BCF national metrics

o   Any additional contributions to BCF section 75 agreements

 

3.Governance

 

3.1     The Brighton & Hove Health and Wellbeing Board (HWB) retains responsibility for governance and oversight of the BCF and receives quarterly monitoring reports. Responsibility for ongoing oversight is delegated to the Health and Care Partnership (HCP) Executive Board which meets monthly. The core responsibilities of the BCF Steering Group in relation to the BCF are in the section 75 Agreement.

 

3.2      In addition to approval of the plan there is ongoing and regular stakeholder engagement. For example, with providers in respect of discharge planning and monitoring, system performance, and at individual scheme level with NHS providers, private sector providers, VCSE providers, and housing authorities.

 

 

4. National BCF Planning Guidance and Requirements for 2022/23

4.1       The 2022/23 BCF Policy Framework and Planning Guidance was published on 19th July with local plans to be submitted by 26th September.

 

4.2       The Better Care Fund plans for 2022/23 include:

 

 

5          BCF National Conditions

5.1       National conditions 1-3 for the fund are broadly similar to 2021-22 and continue to require a minimum spend level on social care from the NHS minimum contribution. National condition 4 requires that local partners should have an agreed approach to implementing the two policy objectives for the BCF, set out in the Policy Framework:

1.    Enable people to stay well,

2.    Provide the right care in the right place at the right time.

5.2       These approaches are outlined in the narrative plan and includes:

·         Approaches to integrating care to deliver better outcomes, including how collaborative commissioning will support this and how primary, intermediate, community and social care services are being delivered to support people to remain at home, or return home following an episode of inpatient hospital care.

·         How BCF funded services support delivery of the objectives.

·         Local implementation of the High Impact Change Model with identified actions. 

6.         BCF Metrics

The length of stay metric used in previous years is not part of requirements in 2022-23. However, it will remain a priority and the data will continue to be provided and monitored regionally and nationally. The metrics included in the new planning template that will be measured for this year are:

Metric

Detail

Avoidable admissions

Unplanned Admissions for chronic ambulatory care sensitive conditions

Residential care admissions

Annual rate of older people whose long-term support needs are best met by admission to residential and nursing care homes

Effectiveness of reablement

People over 65 still at home 91 days after discharge from hospital with reablement

Discharge destination

Percentage of discharges to a person’s usual place of residence

 

 

7.         Financial Allocations

Funding Sources

Income

DFG

 

£2,312,933

Minimum NHS Contribution

£22,723,963

iBCF

 

£9,459,107

Additional LA Contribution

£523,046

Additional ICB Contribution

£0

Total

 

£35,019,049

 

7.1    The BCF requires the ICB to make minimum contributions from its base budget. The allocation is governed by national Better Care Fund Policy Framework and Better Care Fund planning requirements 2022-23.  The funds are covered by a legal s75 agreement.

 

7.2       The planning requirements set out national conditions that must be met for a plan to be assessed as compliant and for NHSE to be able to assure each plan.  The Brighton & Hove BCF plans meet the national conditions.

 

7.3       The NHS minimum contribution to the BCF has increased by 5.66% in 2022/23.

 

7.4       Improved Better Care Fund (iBCF) and Disabled Facilities Grant (DFG) conditions remain broadly the same and have been issued to local authorities the iBCF has increased by 3%. The Adult Social Care contribution and NHS commissioned Out of Hospital Services ringfences to increase in line with the overall increase i.e. 5.66%. The investment plan for Brighton & Hove is reported at Appendix 2 and demonstrate achievement of the minimum required spend on both NHS Commissioned Out of Hospital services and Adult Social Care Services.

 

 

7.5       In Brighton & Hove new funding has been allocated to provide project to support to the transformation of community services (£72k) alongside support for High intensity users (£58k).  The remaining balance is currently being held in reserves and will be allocated to support hospital discharge.

 

7.6       Risks related to the BCF plans are assessed as low, the majority of schemes funded by the BCF are established services and their delivery and impact was the subject of a review in late 2021/22.  Risk of plans not being compliant or not assured is assessed as low.


7          Conclusion

 

7.1       The Brighton and Hove BCF submission meets the national planning guidance and policy requirements. A financial analysis of the plan provide assurance that national requirements and conditions will be met. The analysis can confirm that the Brighton and Hove Plan meets the requirements to spend the BCF mandated minimum contribution and the schemes, and the model of delivery adopted is in line with the three main policy areas.

 

7.2       The investment being made will support the strategic and operational requirements of each system in particular supporting discharges and admission avoidance. This is particularly important this year due to the increased pressure being and expected to be experienced in coming months as we move through the fragile restoration period of the Covid pandemic. 

 

8.         Important considerations and implications

 

 

8.1      Legal: This report contains recommendations to note and therefore there are no legal implications arising from it.

 

 

 

 

Lawyer consulted:        Elizabeth Culbert                     Date: 17/10/22

 

 

            Finance:

 

8.2      The Better Care Fund is a section 75 pooled budget which totals £35.019m for

            2022/23. The ICB contribution to the pooled budget is £22.724m and the Council contribution is £12.295m, which includes the £9.459m Improved Better Care fund. Any spend variance at outturn is subject to a risk share as per the section 75 agreement.

 

           

Finance Officer consulted:     Sophie Warburton        Date: 12/10/2022

 

 

 

 

 

 

Equalities:

The BCF plans set out in the narrative submission specifically how the schemes invested in will support the equalities and health inequalities of their local population. Individual EHIAs are carried out for specific new schemes as they are developed.  All schemes funded by the NHS are required to apply EHIA processes to of all services commissioned.  The plans and strategies have been developed jointly based upon detailed population analysis, reflecting the Place based plans that are informed by EHIAs and the local JSNAs.

There is not a formal public and engagement process supporting this annual process, but individual schemes will be informed by views of patients and public. 

 

 

Health, social care, children’s services and public health:

The BCF plans set out in the narrative submission specifically how the schemes invested in will support equalities and health inequalities policy and requirements of their local population. The development, agreement and delivery of the plan is the responsibility of the local Health and Wellbeing board. 

 

 

 

 

 

Supporting documents and information

 

            Appendix 1: Narrative Submission

            Appendix 2: Financial Schedule

 

 

 

 

           

Appendix 2