Health and Wellbeing Board	5 May 2021
Report of the Assistant Director – Joint Commissioning, City of York Council and Vale of York Clinical Commissioning Group

Better Care Fund Update

Summary

1. This report is to provide an update on:

· the national reporting process for the 2020-21 BCF Plan,

· progress of the Better Care Fund Review,

· the national small grants scheme, and

· the planning arrangements for 2021-22.

Background

2. The background information on the BCF has been previously reported to the Health and Wellbeing Board (HWBB), with quarterly updates now the normal routine, most recently in March 2021.

3. The government has not published a Policy Framework and Planning Requirements for 2020-21, and HWBBs were not required to submit a plan for the year.  The traditional processes have been interrupted by the pandemic.  The York plan has largely followed the pattern of previous years, and we have referred to it as a ‘roll forward’ of the schemes.

Main/Key Issues to be Considered

National reporting process for the 2020-21 BCF Plan

4. The Better Care Team (NHSE&I) has issued an End of Year template to report on the BCF expenditure in 2020-21.  The template is due to be submitted by 24^th May 2021, and is currently being prepared by the CCG and council finance teams.  This submission must be signed off by the HWBB.  

5. The HWBB must also confirm that York is compliant with the four national conditions (as is the case). The national conditions for the BCF in 2020-21 are that:

· Plans covering all mandatory funding contributions have been agreed by HWB areas and minimum contributions are pooled in a section 75 agreement (an agreement made under section 75 of the NHS Act 2006).

· The contribution to social care from the CCG via the BCF is agreed and meets or exceeds the minimum expectation.

· Spend on CCG commissioned out of hospital services meets or exceeds the minimum ringfence.

· CCGs and local authorities confirm compliance with the above conditions to their Health and Wellbeing Boards.

6. As this falls between meetings, it is recommended that the Chair be delegated to sign off the submission on behalf of the HWBB.

Progress of the Better Care Fund Review

7. As 2021-22 will be the third, successive, single year plan, the council and CCG agreed to review the York BCF to ensure we are achieving the right outcomes and the best value from the pooled investment. The HWBB supported the establishment of a small review team and the proposed approach to ensuring that the BCF is delivering the greatest impact possible.

8. Schemes in York have been given an interim commitment of continuation until at least 30^th June 2021.  The intention is to complete the review in four phases, which are set out below, and the review team is on track to fulfil this. 

i. Priority Preventative Schemes dependent on fixed term posts (complete)

ii. Priority Preventative Schemes with possible impact on fixed term posts (complete)

iii. Remaining schemes in which BCF allocation underpins the cost of ongoing service, but not necessarily linked to specific posts at risk (April 2021 – on track at the time of writing)

iv. Use the annual evaluation days to consider whole system shifts possible by using the totality of the fund more strategically as an outcome from the scheme by scheme reviews.  We will take account of interdependencies, integration, and opportunities to make a bigger impact through integration, collaboration and transformation.           (May 2021 – evaluation sessions have been scheduled)

9. The previous report (March 2021) included headline findings from the first nine schemes to be reviewed.  Annex 1 takes the form of a presentation providing an overview of the findings to date.  These include overarching messages which are applicable to the whole programme so far, and a summary of tailored actions for commissioners and scheme providers.

10. Detailed findings and further questions are being discussed with individual schemes as the work progresses, and will inform the agenda of the Better Care Fund Performance and Delivery Group as we begin to plan for longer term investments from 2022 onwards. 

11. It remains our expectation that the government will establish a standalone BCF, and enable multi-year agreements to be reached.  This will have positive advantages in York, in particular to reduce our reliance on fixed term contracts and enable expansion of core preventative services, such as the long-standing commitment to extend Local Area Co-ordination to more areas of the city.

The National Small Grants Scheme 2020-21

12. York was successful in its bid for an award from the National Small Grants Scheme in March 2020, securing the maximum allocation of £15,000 to pilot an innovative model of short term care in partnership with North Yorkshire BCF and Care Rooms Ltd.  The pilot is for six months initially.  The successful bid (mirrored by North Yorkshire) is attached at Annex 2.

13. We are currently in the process of establishing a reference group as a support network for the provider of the pilot, and will report on our learning to the HWBB later in the year.

The Planning Arrangements for 2021-22

14. The NHS 2021/22 priorities and operational planning guidance was published on 25 March 2021, along with the guidance on finance and contracting arrangements for H1 2021/22 (H1 refers to the first half of the financial year).   It includes the following reference to BCF:

The government has confirmed that the Better Care Fund (BCF) will continue in 2021/22 and that the CCG minimum contribution will grow (in line with the planned Long Term Plan settlement) by 5.3% to £4.26bn. As part of the H1 arrangements, CCGs' envelopes include funding for growth to enable CCGs to meet their 2021/22 BCF commitments. Details of the national conditions and processes for the BCF will be set out in due course in the BCF policy and planning guidance.

15. The guidance has not been published at the time or writing, therefore the HWBB will be notified of it through a future report.

Consultation

16. The BCF Plan 2020-21 was developed in a collaborative process with partners, and is co-produced with the scheme providers.  This approach will be continued for 2021-22.  The BCF Performance and Delivery Group discusses the progress of the review at each meeting, and sessions are co-produced.  The council corporate management team has received reports on this work in February, March and April 2021.

Options      

17. The HWBB will receive further reports on the progress of the review and the publication of the national planning requirements when this occurs.   

Analysis

18. n/a

Strategic/Operational Plans

19. The Joint Health and Wellbeing Strategy is the overarching strategic vision for York; this plan supports the delivery of the desired outcomes.

20. The York BCF Plan 2017-19 provided the foundation for the BCF Plan 2019-20 and 2020-21.  It has evolved each year in line with refreshed intelligence and national directives.

21. This work is congruent with the Council Plan and the NHS Long Term Plan.  The NHS White Paper further promotes the policy objectives of BCF. The link is included below under background papers, and also the link to the NHS planning guidance referred to in paragraph 14 above.

22. BCF schemes have been central to the COVID-19 pandemic response, including the implementation of the Hospital Discharge Policy.

        Implications

· Financial – There are no new financial implications as yet from this report. Any future decisions about investment or disinvestment would be consulted upon with partners and would have legal governance and assurance through the section 75 agreement used to establish the BCF pooled budget.

· Human Resources (HR) – many of the schemes funded through BCF are supported by staff on fixed term contracts.  The prevalence of short-term funding and fixed term employment contracts are a significant risk to the stability and continuity of our system.  The review has prioritised the schemes which are most affected.  CYC staff contracts have now been extended where required.

· Equalities - none

· Legal - none

· Crime and Disorder  - none

· Information Technology (IT) – information technology and digital integration forms part of the system wide improvement plan, relevant representatives from statutory agencies attend the project board, and there are plans to engage non-statutory services and the patients, customers and families in our developments.  The national and regional work on this agenda guides our local work.

· Property - none

· Other – none.

Risk Management

23. Governance processes are in place between the partners to manage the strategic risks of the BCF as part of our whole system working.

        Recommendations

24. The Health and Wellbeing Board are asked to:

i. Receive the York Better Care Fund update for information.

Reason:  The HWBB is the accountable body for the Better Care Fund.

ii. Delegate authority to the Chair to sign off the End of Year Expenditure template prior to submission

Reason: The submission date of 24 May falls between meetings of the board.  This convention has been adopted routinely for previous submissions to NHSE.

iii. Note the progress of the review of the financial allocations for BCF 2021-22 to ensure maximum impact on outcomes for the system.

Reason: It is important for the sustainability and stability of the whole system that the funding commitment is reviewed regularly to be assured of value for money and impact on outcomes.  The Chair and Vice Chair, have approved this approach, supported by the council Corporate Director of People and the CCG Accountable Officer.

iv. Receive further reports on the progress and outcomes from the BCF review at future meetings.

Reason: The HWBB is the accountable body for the Better Care Fund.

Contact Details

Author:	Chief Officer Responsible for the report:
Pippa Corner Assistant Director – Joint Commissioning People Directorate City of York Council & NHS Vale of York CCG 07500973261 pippa.corner@york.gov.uk	Amanda Hatton Corporate Director - People City of York Council Phil Mettam Accountable Officer NHS Vale of York CCG
	Report Approved	X	Date	23.04.2021
	Report Approved	X	Date	23.04.2021
Wards Affected:					All	x
For further information please contact the author of the report

Background Papers:

Marmot Review – available at:

Build Back Fairer: The COVID-19 Marmot Review

NHS White Paper – available at:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/960548/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-web-version.pdf

NHS 2021/22 priorities and operational planning guidance

NHS England » 2021/22 priorities and operational planning guidance

NHS Guidance on finance and contracting arrangements for H1 2021/22

Report template - NHSI website (england.nhs.uk)

Annexes:

Annex 1 – Overview presentation on the BCF Review

Annex 2 – York bid to national small grant scheme

Glossary

A&E – Accident and Emergency

BCF – Better Care Fund

BI – Be Independent

CCG – Clinical Commissioning Group

CYC – City of York Council

DHSC - Department of Health and Social Care

DToC – Delayed Transfers of Care

ED - Emergency Department

GP – General Practitioner

HR – Human Resources

HSG – Human Support Group

HWBB – Health and Wellbeing Board

IT – Information Technology

KPI – Key Performance Indicator

LAC – Local Area Co-ordinator / Local Are Co-ordination

MDT – Multi-Disciplinary Team

NHS - National Health Service

NHSE&I - NHS England & Improvement

RATS - Rapid Assessment and Therapy Service

SDEC - Same Day Emergency Care

VOYCCG – Vale of York Clinical Commissioning Group

YTH – York Teaching Hospital