Health and Wellbeing Board

21st July 2021

 

Final 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

·        2020-21 Performance report

·        progress of the Better Care Fund Review

·        recommendation on Intermediate Care

·        the planning arrangements for 2021-22

·        recommendation to review the BCF Performance and Delivery Group Terms of Reference

       

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 May 2021.

 

3.           The government did not publish 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 from 2019-20.

 

Main/Key Issues to be considered

National reporting process for the 2020-21 BCF Plan

4.           The Better Care Team (NHSE&I) issued an End of Year template to report on the BCF expenditure in 2020-21.  The template was submitted ahead of the 24th May 2021 deadline, as agreed at the HWBB meeting earlier that month.  The submission was signed off by the chair of HWBB.   The full excel template is attached at Annex 1, and the strategic narrative has been provided as a word document excerpt at Annex 2 for readers’ convenience.

 

Performance update

5.           There are four key performance indicators which have been associated with the BCF since its inception, and which have been reported to the HWBB in previous years.  During the pandemic the reporting requirements changed, for example there is now no submission on Delayed Transfers of Care, and the non-elective admissions to hospital cannot be compared to earlier years due to the drastic change in circumstances across the health and care system.

6.           The BCF key performance indicator dashboard confirming the outturn for 2020-21 is attached at Annex 3.

 

Progress of the Better Care Fund Review

7.           As 2021-22 is 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 were given an interim commitment of continuation until at least 30th June 2021.  The review has been completed in line with the timetable previously reported to the HWBB.  The annual evaluation sessions with schemes have also been held in May, bringing together a rich picture of the outcomes achieved for local people, under the ‘BCF umbrella’.  Schemes were asked to present their information under headings which will support the preparation of the annual report to HWBB in the autumn of 2021, and also to respond to the key lines of enquiry linked to BCF in the NHSEI returns. 

 

9.           The previous reports on the BCF review included an overview of the findings to date.  The overarching messages which are applicable to the whole programme are set out below:

a.   Make improvements to the business processes and contractual arrangements between commissioners and scheme providers to simplify bureaucracy, reduce duplication, increase clarity and timeliness.  Treat schemes proportionately in relation to reporting requirements.  Where possible place schemes on a sustainable, secure footing for the longer term.

 

b.   Use the positive review findings in 2020-21 as the baseline for future plans and consider all opportunities to add value and further improve outcomes in future. Develop our thinking around the range of currencies we apply to gauge the value of schemes.

 

c.   Develop an Intermediate Care Strategy for York, alongside undertaking an End to End, whole system redesign of Intermediate Care, based on an evidence based assessment of the level of true demand and the capacity requirement for the range of relevant services.

 

d.   Schedule an End to End review of Equipment and Assistive Technology and related services as a further area for whole system planning and improvement.

 

e.   Provide a clear narrative on the history and heritage of the York BCF Plan – differentiate between the schemes where BCF provides 100% of the budget and those where BCF makes a contribution to a larger budget.

·        100% BCF: Review Group and Partners can instigate or direct review / redesign / service improvement

·        BCF contribution: BCF partners are stakeholders who support wider system experts to review / redesign / improve services.  BCF can influence and shape direction of travel towards integration, prevention, collaboration.

·        Group schemes according to high level themes within the financial plan to highlight interdependencies and opportunities for further collaboration.

 

10.        The detailed findings 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. 

Intermediate Care

12.        Among the review recommendations, the most significant area of work to be taken forward is related to the development of an Intermediate Care Strategy for York, taking account of best practice guidance and a refreshed assessment of our true demand and service capacity. 

13.        The BCF Performance and Delivery Group agreed the need for this work to be carried out, and supported the establishment of a small group to take this forward.  The refresh of the Venn Demand and Capacity model provides a starting point for this work, and further proposals will be drawn up about the resourcing and practical implementation of this across the partnership.  HWBB sponsorship for the development of an Intermediate Care Strategy is requested, in the context of the overarching Joint Health and Wellbeing Strategy.

The National Small Grants Scheme 2020-21

14.        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 pilot is in progress, with a reference group having been established as a support network for the provider of the pilot.  We will report on our learning to the HWBB later in the year or early in 2022.

 

 

The Planning Arrangements for 2021-22

15.        The detailed planning guidance has not been published at the time or writing, therefore the HWBB will be notified of any changes through a future report.  Areas have been advised to plan for its continuation through existing funding streams, with allocations and grant determinations already in place, for example iBCF and Disabled Facilities Grant.

16.        The financial plan for 2021 – 22 was developed and supported by the Performance and Delivery Group in June 2021.  It is therefore recommended for formal approval by the HWBB.  It is attached at Annex 4.

17.        As we prepare for the planning process for future years it is a suitable time to review the Terms of Reference for the BCF Performance and Delivery Group, last updated in January 2018.  These are attached at Annex 5.  Since that time there have been changes in local organisational structures and representation, and we anticipate further changes to the legislative framework, in line with the NHS White Paper. 

Consultation

18.        The BCF Plan 2021-22 has been developed in a collaborative process with partners, and is co-produced with the scheme providers, taking account of the learning from the review process.  The BCF Performance and Delivery Group discussed the draft financial plan at the June meeting, and confirmed the investment intentions.

Options      

19.           n/a

Analysis

 

20.        n/a

Strategic/Operational Plans

 

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

22.        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.

23.        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.

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

        Implications

·         Financial – The financial plan has been developed with the detailed support of the finance officers of the CCG and council. It is compliant with regulations, and will be monitored quarterly through the BCF Performance and Delivery Group.  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

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

        Recommendations

26.        The Health and Wellbeing Board are asked to:

               i.           Receive the York Better Care Fund update for information, including the formal submission of the 2020-21 End of Year report to NHSEI.

Reason: 

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

              ii.           Approve the financial plan for 2021-22.

Reason:

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

             iii.          Support the development of a new, multi-agency Intermediate Care Strategy for York.

Reason:

York does not currently have a strategy in place to cover the range of services described as Intermediate Care.

             iv.          Receive further reports on the progress and outcomes from the Care Rooms pilot project.

Reason:

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

              v.          Instigate a review of the terms of Reference for the Performance and Delivery Group to reflect changes in the local and national arrangements and to prepare for future requirements.

Reason:

The Terms of Reference have not been updated since 2018.

 

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

 

 

Amanda Hatton

Corporate Director - People

City of York Council

 

 

 

Report Approved

✔

Date

06.07.2021

 

 

 

 

 

 

Wards Affected: 

All

x

 

 

 

 

For further information please contact the author of the report

 

Background Papers:

 

 

Annexes

 

Annex 1 – NHSEI End of Year Template 2020-2021

 

Annex 2 – excerpt from the end of year template – strategic narrative

 

Annex 3 – BCF KPI Performance Dashboard 2020 -21

 

Annex 4 – 2021 - 22 Financial Plan

 

Annex 5 – BCF Performance and Delivery Group terms of reference

 

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