York Health and Wellbeing Board

Health and Wellbeing Board        20 July 2022                              

Report of the Corporate Director of Adult Services and Integration and Interim Director of Children Services.

Better Care Fund Update

Summary

1. This report is to provide an update on:

· Better Care Fund.

· 2021/2022 year end sign off.

· Progress on the reablement and intermediate care pathway redesign.

Background

2. The Better Care Fund framework was published in September 2021. Through the Better care Fund delivery group partners completed a narrative plan that has previously been shared and signed off by the Health and Wellbeing board.

3. In addition to this the Better Care Fund delivery group agreed to commission Venn consulting to review our early intervention, reablement and crisis care pathway. This review has provided an opportunity for partners in particular health and social care to explore further alignment of assessment and delivery.

4. The Venn consulting review highlighted areas of opportunity and challenge as well as  supporting a reduction in high cost crisis care.

5. The report in particular stated our early intervention approaches were good and supported people to remain at home with little or no support from statutory services. However our reablement and intermediate care pathways through health and social care were disjointed with over five different referral pathways, complex handovers, and differing eligibility criteria, making access into services difficult for both staff and individuals to navigate.

6. The performance target for reablement supports this view as month on month the target has not been met. This is due to a combination of factors including the Venn’s observations above, as well as wider external market care availability.

National reporting process for the 2021-22 BCF Plan -  

7. The Better Care Team (NHSE&I) issued the BCF Planning template for 2021-22. A year end plan has been submitted, however requires formal sign off by the Health and Well Being Board.

8. Attached is the 2021-22 planning template for approval by the Health and Wellbeing Board.

9. A further plan will commence for 22/23 and will be shared with the Health and Wellbeing Board in October 2022.

Performance update-

10. There are four key performance indicators:

· Avoidable admissions.

· Length of stay.

· People staying at home after discharge into reablement services.

· Admissions of older people to residential/nursing care homes.

11. Avoidable admissions: The new target of avoidable admission came in September as part of the updated BCF planning guidance. Workforce challenges, covid and patients requiring additional acute care has meant that this target has not been met. We are as a system 3% over the target set for York. Further work is ongoing to ensure we work towards reducing avoidable hospital admissions through out of hospital support and a review of urgent care.

12. Length of Stay: This is a new target set within the Better Care Fund planning guidance in September 2021. It replaces the delayed discharges target. The system has not managed to reach this target and further work is required to ensure the target is met through 22/.23.

13. People staying at home after discharge from hospital into reablement/rehabilitation services: in 21/22, 87.9% of older people (aged 65 or over) that were discharged into reablement/rehabilitation services were found to be still living at home 91 days after leaving hospital. This target has improved from last year as well as being higher than the national average (79%) and higher than the Yorkshire and Humber regional average (76%). However there has been significant increases in care required to support people to remain at home and this has created overspends within Council budgets.

14. Admissions of older people into residential/nursing care: in 21/22, there were 192 admissions of older people (aged 65 or over) into residential/nursing care homes in York that were arranged by City of York Council, this is a rate of 525 per 100,000 population. This is a rise from 20/21 where we had 135 admissions in to residential or nursing care. This is due to a combination of the D2A programme as well as higher patient need.

Progress of the Better Care Fund Review

15. A review of schemes is underway to ensure all schemes listed in appendix 1 are the right schemes and supporting better outcomes. The Better Care Fund delivery group has been tasked to review and recommission/redesign schemes as required.

Consultation

16. The Better Care Fund Plan 2021-22 has been developed within a collaborative process with partners across health, social care and the community and voluntary sector, and is co-produced with the scheme providers, taking account of the learning from the previous year review process.  The Better Care Fund Performance and Delivery Group discussed the draft financial plan at the May 22 meeting, and confirmed the end of year plan.

Options      

17. n/a

Analysis

18. n/a

Strategic Direction /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, reducing inequalities, supporting better health outcomes. This strategy is currently being refreshed and is to be published later in the year.

20. This work is congruent with the Council Plan and the NHS Long Term Plan. The White paper on integration as well as the Health and Care act responsibilities.

21. Financial – The financial plan has been developed with the detailed support of the finance officers of the CCG and council and approved by the HWBB on 21^st July 2021. No major variances are anticipated at this point. 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.  The total BCF budget for 21/22 is £20,010,81

22. Human Resources (HR) – many of the schemes funded through Better Care Fund are supported by staff on fixed term contracts.  The prevalence of short-term funding and fixed term employment contracts remain a significant risk to the stability and continuity of our system.   

23. Equalities – none

24. Legal – none

25. Crime and Disorder  - none

26. 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.

27. Property – none

28. Other – none.

29. Risk Management. A Memorandum of understanding for 21/22 and 22/23 has been agreed, however further clarity is required for subsequent years.

30. Governance processes are in place between the partners to manage the strategic risks of the Better Care Fund as part of our whole system working. Updates on this programme will also be provided to the York Health and Care Place Board.

        Recommendations

31. The Health and Wellbeing Board are asked to:

· Receive the York Better Care Fund update for information.

· Agree the attached 21/22 year end return.

· Agree delegated authority for future returns to be signed off by the Corporate Director of Adults and Integration, appropriate ICS lead in partnership with the HWBB chair Cllr Runciman.

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

Contact Details

Author:	HWWB Chair:
Jamaila Hussain Corporate Director of Adult services and Integration and interim Director of Children Services.	Cllr Carol Runciman HWBB Chair City of York Council
	Report Approved	tick	Date	Insert Date
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Wards Affected:  List wards affected or tick box to indicate all [most reports presented to the Health and Wellbeing Board will affect all wards in the city – however there may be times that only a specific area is affected and this should be made clear]					All	x
For further information please contact the author of the report

Background Papers:

Annexes – All –        

 Annex 1 – 2021 - 22 schemes

 Appendix 2 Attached

BCF Schemes 2021-22

Scheme	Expenditure (all figures in £000)
Urgent Care Practitioners	£509.78
Street Triage	£159.05
Disabled Facilities Grant and falls prevention	£1,468.00
Reablement contract	£1,130.62
Packages of Care – Care at Home	£4,411.11
Packages of Care - Placements	£731.96
Contribution to social work staff capacity – BAU and Statutory Duties	£867.00
Carers’ Centre	£363.00
Carers’ Support	£145.00
Carers’ support workers posts	£168.67
Be Independent	£458.25
Out of Hospital Services	£6,270.77
Local Area Co-ordination	£293.62
Live Well York	£50.98
Health Champions	£35.00
Ways to Wellbeing	£160.68
Alcohol Prevention	£48.55
Small Tasks at Home	£30.60
Cultural Commissioning	£30.00
Community Response Team (CRT)	£128.55
Rapid Assessment and Therapy Service (RATS)	£214.82
Self-Support Champions	£102.00
Home From Hospital	£54.00
Hospice at Home (H@H)	£203.00
York Integrated Care Team (YICT) / Priory Outreach	£997.29
A Bed Ahead and Vaccinations outreach	£89.51
Fulford Nursing Home & other Step Up / Down beds	£520.90
Venn Capacity and Demand	£40.00
BCF Support Role	£20.00
IT support for single care record	£10.00
Move Mates	£40.00
Dementia Support	£31.70
NQ Project manager	£20.00
CCG VCS contracts	£174.00
Health Champion - additional hours	£8.00
Additional OT in step down beds (M1-6 only)	£23.70
Total Expenditure	£20,010.81

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