Agenda item

To receive an update following the workshop to "reset" the Better Care Fund in Lancashire including:

·  2022/2023 Better Care Fund Approval

·  Better Care Fund Reset Planning

·  Adult Social Care Hospital Discharge Fund Plan and Reporting

Paul Robinson, Midlands and Lancashire Commissioning Support Unit, NHS and Sue Lott, Adult Social Care, Lancashire County Council updated the Health and Wellbeing Board following the workshop to "reset" the Better Care Fund in Lancashire.  Further detailed information can be found in the report.

The Board were reminded that there was a spend of £174 million across Lancashire and within that it covers a minimum spend from the Integrated Care Board allocation of just under £70 million on NHS Commissioned Out of Hospital services and just under £40 million on Adult Social Care services spend. 

The plan was approved nationally at the end of December 2022 and the approval letters sent shortly after that.  There has been no reporting requirement other than to the Health and Wellbeing Board at a national or regional level, however, it is expected that there will be an end of year reporting requirement, which will be presented to this Board when available.

The Board noted that a Section 75 agreement was required that covers the management of the Better Care Fund. This is an agreement under section 75 of the NHS Act 2006 and is the mechanism by which the funds across health and social care and manage the Better Care Fund itself.  The pool itself is hosted by Lancashire County Council and ways are being explored as to how the tool can be better used in managing the money across health and social care.  There is a slight delay in the sign off of the agreement due to the Adult Social Care Discharge Fund, however it will be signed of by 31 January 2023.

The report to the Board covers two aspects:

i)  Better Care Fund Reset

ii)  Adult Social Care Discharge Fund

In terms of the Better Care Fund reset, a workshop was held on 1 December 2022 and the outcomes/themes/next steps from the workshop are detailed further at Appendix 'A'.

A steering group has been established and will meet monthly to oversee the programme of work and to focus initially on interim governance setting and the parameters of how to review the spend across the Better Care Fund.  The Board will receive the framework at a future meeting.

With regards to the Adult Social Care – Discharge Support Fund as the Health and Wellbeing Board it has oversight and accountability for the spend within the plan.  The fund was announced in September 2022 and formally confirmed towards the end of November 2022.  The plan had to be submitted by 16 December 2022 and formally signed off by the Chair of the Health and Wellbeing Board, Chief Executives of the Integrated Care Board and the Local Authority and the Local Authority, Section 151 officer.

The support fund itself is a national £500 million fund and it is to be used to support timely and safe discharge from hospital into the community, reducing the number of people delayed in the hospital who are awaiting social care and includes those people on the mental health wards.  It can also be used to boost adult social care and workforce capacity through staff recruitment, staff retention and where that will contribute to reducing delayed discharges.  The funding is split with 60% of the fund directed through to the Integrated Care Boards and 40% through to Local Authorities.  The total combined amount for Lancashire across the Local Authority and the Integrated Care Board is £9.7 million and the monies are to be spent by the end of March 2023.

There are a number of regulations associated with the funding which needs to be met alongside the requirements to provide fortnightly monitoring reports which set out the actual spend, the activity, how many discharges have been achieved and the progress against each of the schemes and the impact that they are making.  The first report was submitted on 6 January 2023 and the second one on 20 January 2023.  

The Board were informed that all the funding has to be pooled into the Better Care Fund, hence the Health and Wellbeing Board's oversight of the plan.  The Lancashire Plan (Appendix 'B') focuses on continuing the many services that were stepped up to support the Discharge to Assess (D2A).  Without the additional funding, those services were at risk of ceasing in November 2022 due to the short-term funding that was previously attached to them.

As the guidance stands currently, the monies cannot be carried over into next year it has to be spent by the end of March 2023, however formal confirmation is awaited to see if this timescale can be extended.

Some other elements of the plan include:

·  Monies identify to facilitate overtime for existing staff, both to meet surges in demand around hospital discharge and hospital escalation pressures, plus extending the mental health discharge team to work across seven days.

·  There is also some money for additional nurse capacity to increase nursing needs assessments directed towards the mental health wards to remove waits for people being delayed on those wards currently.

·  A community intensive support team for mental health to enable people on mental health wards to be discharged earlier.

·  Funding additional community equipment to ensure it is more widely available and to broaden the availability of certain small items that will support people being discharged from all hospitals.

·  Monies to contribute to supporting the social care sector in terms of stability around workforce.

The Board will receive further updates on the progress of this scheme, however so far, the funding has facilitated care and support to approximately 1200 people who have been discharged from hospital over the last 5/6 weeks.

Following the presentation, the following comments were noted:

The Board needs to ensure that they are challenging that the Better Care Fund is being used for integration and to ensure services are being supported by the funding included the Boards three main priorities.

Resolved:  That the Health and Wellbeing Board:

(i)  Noted the progress in the "reset" of the Lancashire Better Care Fund and next steps.

(ii)  Received further updates on reset activity beginning with outcomes of the financial review and recommendations for governance.

(iii)  Noted the approach to using the Adult Social Care Discharge Fund as set out in the plan and formally record Health and Wellbeing Board approval and Chair's sign-off.

(iv)  Received updates on the impact of the use of the Adult Social Care Discharge Fund.