Agenda item

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised Members that the Better Care Fund (BCF) was a national initiative with two objectives:

1.    Enable people to stay well, safe and independent at home for longer; and

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

The first BCF plan had been put in place in 2015/16 and the latest iteration covered a two-year period from April 2023 to March 2025.  The Section 75 (s75) agreement gave legal effect to the financial and partnership arrangements that had been put in place to deliver the BCF objectives.  Cabinet had approved the first year (2023/24) with a one year extension.  

The report had included the national metrics and the Q2 position.  The BCF metrics had an adult focus but work in relation to child related schemes continued to take place.  The Committee was advised that the North West London Integrated Care Board (NWL ICB) had been doing a review of the BCF schemes being undertaken across all NWL boroughs to identify any duplication in service provision.  It was anticipated that there would be a resultant revision in Q4. 

Mr Collier advised that capacity in relation to mental health discharges had been strengthened this year and there had been examples of the delegation of functions between the NHS and social care.  Many features of the legal agreement had remained the same as the previous year.  Monitoring requirements for this last year had been considerable and it was anticipated that this would continue going forward. 

Mr Richard Ellis, the Joint Lead Borough Director at the NWL ICB, advised that there had been an overlap with the previous report on this agenda as some of the BCF funding was used for carer support.  He noted that there was limited local flexibility in terms of how the BCF money was spent but that every effort was made to maximise this flexibility.  Mr Collier advised that the BCF contained different funding schemes and that the local authority had less agency over the ICB additional voluntary contributions.  Some voluntary contributions had been taken out of the BCF but the services that these related to had continued to be provided.  The Council did have some say over the use of the NHS minimum contribution as well as the Improved Better Care Fund and local authority discharge fund and had been very transparent about their use, all of which had positive benefits for Hillingdon’s health and care system.  

Members were advised that £905k core funding for voluntary and community organisations had been removed from the BCF Pooled Budget.  However, the funding was still available for the same services.  This reflected a move to commissioned services rather than providing various organisations with annual grants to deliver services.  Public procurement regulations necessitated that the Council would have to go out to tender for these services but the approach offered a longer-term certainty and stability for the service providers as the Council would be offering contracts of up to 8 years.  Service delivery could also be better monitored by the Council.  Metrics would be reflected in service specifications and monitoring frequency would be proportionate, e.g., contracts of higher value would be subject to more frequent monitoring. 

With regard to the national metrics, some were consistent but there had been changes to others.  This was the first year that the ICB had been established and it had decided to review the eight BCF agreements across NWL to seek “consistency”.  However, it was unclear what was meant by “consistency” as this had not been defined. 

In Hillingdon, effort had been made to get the ICB to understand that there were differences between the 2.5m residents in NWL but a consistent way of managing these issues had not been identified.  Mr Ellis advised that it would be important to ensure that Hillingdon’s interests were protected. 

The NWL ICB review of the BCF had supported Hillingdon’s BCF proposals.  Furthermore, the standards and expectations of the ICB had been met and had been acceptable to the external assessors.  The delegation of the bridging care service from the NHS to social care had been very successful and other boroughs were now being encouraged to introduce similar schemes. 

Members noted that the s75 agreement aimed to drive innovation and integration.  Examples of this could be seen through the initiatives driven by the delegation of functions between the NHS and social care.  There were also some posts that had been funded which had reduced time spent in hospital.  For example, additional staff specialising in mental health had been placed in Hillingdon Hospital’s Emergency Department (ED).  Additional funding had also been put in place for short term care staff to help support fast discharge at the hospital.  Mr Collier advised that he would change the way that updates on the BCF were reported to the Committee to make the impact on residents more tangible. 

It was noted that some residents were concerned about the cost of the additional services that might be needed when they were discharged home.  Mr Collier advised that this was set in a statutory framework for Adult Social Care under the Care Act.  The schedule in the report appendix had referred to funding from short-term support to enable residents to step down from hospital.  Longer term care needs would be subject to a financial assessment as required under the Care Act.  The Pooled Budget covered services that enabled residents to get out of hospital, e.g., bed based services and support to return to the community through the Bridging Care Service. 

The report stated that there were some NHS / ICB funding contributions for 2024/25 which were identified as provisional pending the outcome of the review of out of hospital services and BCF schemes in NWL.  Mr Collier advised that he hoped to have further information about this in January 2024 but that it was less likely that it would change in 2024/25 and that any major changes would be more likely in April 2025 when old contracts would be ending and new ones could be aligned. 

Mr Collier advised that, although not yet published, a national comparator would be available in the near future.  Once available, he would share this information with the Committee and would be able to include it in future reports to show Hillingdon’s position in context.

RESOLVED:  That:

1.    Mr Collier provide Members with information about the national comparators once available; and

2.    the report be noted.