Agenda item

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the 2022/23 Better Care Fund Section 75 (s75) Agreement report was due to be considered by Cabinet at its meeting on 15 December 2022.  The Better Care Fund (BCF) initiative had been in place since 2014/15 to bridge the difference in the legal systems between health and social care.  The BCF worked to a national timetable with planning requirements that had been sent out to local authorities late, hence why the 2022/23 plan legal agreement was only just being taken to Cabinet in December 2022. 

The Council and NHS partners had devised a BCF plan that met national requirements on how local authorities and the NHS should work together to deliver local and national priorities.  This plan had been agreed by Hillingdon’s Health and Wellbeing Board in accordance with national requirements.  The s75 agreement was very detailed, and included such things as setting out the delegation of functions, financial arrangements, meeting jointly agreed objectives and also risk sharing arrangements. 

Mr Collier advised the Committee that the care market was struggling nationally and that Hillingdon was not immune to these pressures.  The Committee was informed that the Council had care market management and development responsibilities under the 2014 Care Act and that these were reflected in the BCF plan and the s75 agreement.  This included channelling Government provided funding to providers as well as support from the Care Home Support Team, which was a collaboration between primary care and the Central and North West London NHS Foundation Trust (CNWL).  This service entailed care homes having allocated care home matrons who contacted them on a regular basis to provide advice and assistance on clinical matters to help prevent crises that could lead to hospital attendances and admissions that were avoidable.

The Committee was further informed that the Council’s Quality Assurance Team was in regular contact with care home and home care companies working in Hillingdon to provide information, advice and support, e.g., explaining Government guidance and requirements.

Mr Collier noted that care home and domiciliary care (also known as homecare) provision were two of the largest areas of spend in the adult social care budget. 

Mr Collier explained that a personal health budget was an amount of money to support a person’s assessed health and wellbeing needs, which was planned and agreed between the person with assessed health needs and the local NHS team.  The Committee was informed that this was similar to personal budgets to meet assessed adult social care needs. 

The Committee was informed that there were different types of personal health budget and, similarly with social care personal budgets, one of these was direct payments where money would go directly to the individual.  Mr Collier advised the Committee that the Council had been managing personal health budgets paid as direct payments on behalf of the NHS for many years as the process was very similar to direct payments meeting social care needs.  The operation of this was reflected in the BCF s75 agreement.  Members noted that a key objective behind the payment of personal health budgets as direct payments was to help empower residents to make their own choices.  Further information about personal health budgets was available at www.nhs.uk. 

Mr Collier made the Committee aware that, in 2021/22, the NHS had funded the first four weeks of new care home and home care placements but that this stopped in 2022.23.  As a result, it had been necessary for financial assessments to take place in hospital again, which could impact on the speed of discharge. 

With regard to the funding for hospital discharge, Mr Collier informed the Committee that the allocations from and grant conditions for the Department of Health and Social Care’s Adult Social Care Hospital Discharge Fund had been announced on 17 and 18 November 2022 respectively.  Under this new fund,

£1.9m was available for Hillingdon’s system and £877k would be paid directly to the Council.  However, a condition of receiving the funding was that a spending plan had to be submitted by 16 December 2022 that had been agreed by the Health and Wellbeing Board.  It was added that this money had to be spent by 31 March 2023.  It was a national requirement that the allocation from this new fund was included within the BCF s75.  Mr Collier advised the Committee that this would necessitate a variation to the agreement and that Cabinet would be asked to agree delegation arrangements to allow necessary changes to the agreement to be made. 

Under the Section 75 agreement, the partners agreed to establish and maintain a pooled fund for revenue and capital expenditure.  This pooled fund was hosted by the Council and was used for a range of services, including those intended to get people out of hospital as quickly as possible but also services to prevent admission.  Discharge-related services were provided by a range of providers including CNWL, care homes, domiciliary care and third sector organisations such as Age UK.  Access to these services would be mainly through the integrated discharge team.  Mr Collier advised that, unlike many health and care systems, Hillingdon did not experience discharge delays due to lack of packages of care as it had a bridging care service in place for up to seven days to then determine if there was a need for reablement or a home care agency for ongoing care.  The Committee was informed that there were issues with care home capacity as Hillingdon had high levels of occupancy in, i.e., 93%.  Mr Collier advised that to address this, beds had block booked by the Council to enable residents to ‘step-down’ over the winter period.  Mr Sean Bidewell, Joint Lead Borough Director at North West London Integrated Care System (NWL ICS), advised that NWL ICS was involved with the discharge work on a daily basis. 

RESOLVED:  That the report and presentation be noted.