Agenda item

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the 2025/26 Better Care Fund (BCF) Plan had been submitted and was compliant with national requirements.  There had been a 3.93% increase in the NHS contribution to adult social care and a 13% increase in Disabled Facilities Grant (DFG) funding.  The North West London Integrated Care Board (NWL ICB) discharge fund had been ringfenced, but the value was the same as it had been for 2024/25. 

The Board was advised that the BCF Plan had been restructured to make it simpler and more streamlined.  The submission had included the Plan template with details of three metrics and financials.  The overall value of the Plan had reduced from £100m to around £74m due to a reduction in the contributions from the local authority and NWL ICB.  The ICB had reduced its additional contribution to the BCF in 2025/26 by 50% which had resulted in savings of £796,619.  The expectation was that the NHS additional contribution to the BCF would reduce by a further £718,608 from 2026/27 making a full year saving for 2026/27 of £1,515,227.  Whilst some of these savings would be quite straight forward, others would need an equalities impact assessment undertaken.

Ms Sandra Taylor, the Council’s Corporate Director of Adult Social Care and Health, advised that this £1.5m reduction meant that it would not be possible to just roll over what had been done in previous years.  Everything had had to be realigned and would need to be constantly reviewed. 

With regard to mental health, Mr Collier confirmed that there was nothing that had been included in the 2024/25 Plan that would be coming out of the 2025/26 Plan.  In response to a query about whether the overall funding had gone up, down or stayed the same, the Board was advised that funding for mandated schemes had increased and that there had been a reduction in the NWL ICB contribution.  However, although the local authority contribution had decreased, there had been no change to the services provided which were funded outside of the BCF. 

There were three national metrics in 2025/26 in relation to emergency admissions to hospital, discharge delays and permanent admissions to care homes.  These improved NHS targets had been based on the data that had been available but there had been some issues with the data available in relation to discharge to the usual place of residence.  The 2024/25 projected outturn had been used as a baseline to create base lines for the 2025/26 plans and a 1% improvement applied.  Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, noted that this 1% did not just sit here and consideration needed to be given to what more could be done with the funding that was available.  There would be an opportunity to review the targets when the Q1 update was undertaken next month. 

The Whole System Integrated Care (WSIC) dashboards linked provider data from four acute, two mental health and two community Trusts across NWL, 380 GP practices and social care data from eight boroughs to generate one of the largest integrated care records in the country.  Ms Amanda Carey-McDermott, Hillingdon GP Confederation, noted that WSIC did not provide live or up to date data.  Partners would be able to do more but only if these data sharing issues were resolved. 

The report set out the priorities.  Mr Keith Spencer, Co-Chair and Managing Director of Hillingdon Health and Care Partners, advised that partners needed to be more radical and ambitious in using the BCF to drive the priorities identified (this had been discussed in detail under the previous agenda item).

Professor Ian Goodman, NWL ICB, noted that Hillingdon had been at the front with regard to digital interventions.  He queried how much digital innovation could be used to stretch the BCF money further.  Ms Taylor advised that the digital strategy had provided some good solutions for staff to use (some of these had been in place for 18 months).  However, the technology in social care had not really moved on and residents were instead being encouraged to use normalised technology to help themselves (for example, bed sensors, door sensors, etc) which would help to keep them out of care placements.  About ten years ago, no one was discharged from hospital without having Telecareline in place first (this might have involved having to have a new line installed at the residents’ home so could be time consuming).  Today’s technology was quicker and easier to install without the need for major works which meant that it was also quicker to remove when it was no longer needed. 

Councillor Jane Palmer, Co-Chair and Cabinet Member for Health and Social Care, noted that not all residents were at ease with technology.  As such, consideration needed to be given to how partners communicated and delivered technological solutions to them. 

Mr Spencer noted that there were almost 10k residents in Hillingdon with severe frailty.  As it was currently unknown, effort was being made to identify where these patients were right now.  The answer had not been readily available.  Consideration would need to be given to how such information could be more easily obtainable in future.  Ms Carey-McDermott noted that the Confederation was in discussions about mobile diagnostics that would be small enough to be transported on a moped but that they needed a bigger cohort to work with than just care homes.  She suggested that these 10k frail residents be included in the cohort. 

RESOLVED:  That:

1. the 2025/26 Better Care Fund Plan as described in the report, including the proposed financial arrangements and proposed targets for the national metrics, be approved; and
2. the position regarding Equality and Health Impact Assessments, as set out in the report, be noted.