Meeting documents

To receive the report and presentation.

The Somerset Health and Wellbeing Board noted, considered and commented on the information and presentation. The Board noted the Better Care Fund 2021/22 submission and the Section 75 Better Care Fund Report.

The Chair noted the two additional papers for this item published as a supplementary agenda and invited the Deputy Direct of Adults and Health Commissioning, along with colleagues from Sedgemoor District Council and Somerset CCG, to make the presentation.

The presentation on "Better Joined Up Commissioning & The Better Care Fund" began with The Better Care Fund, which is focused on collaboration; and it was noted that the future way of working of the BCF could be similar to that of the Integrated Care System (ICS).  The BCF has been focused on joined-up working and joined-up funding, although the latter has come from already existing funding (no new monies).  There is a current opportunity insofar as Section 75 Agreements allow statutory bodies to pool funding and resources.  The BCF budgetary areas for 2021/22 cover the Disabled Facilities Grant, the iBCF, and the NHS Somerset CCG (a mandated contribution), totalling £70,825.643.  This includes NHS funding towards social care and for out-of-hospital care and support.  The national BCF metrics involve reductions in unplanned admissions to hospital, delays in people going home after hospital stays, people 65 and over who can remain in their homes for more than 91 days, and the rate at which people go into long-term care.

"Good Homes for All – Flexible Approaches to Using S.75 Funding" was then presented; this involves the flexible use of the BCF to support Healthy Neighbourhoods/Healthy Housing.  This system entails sourcing accommodation and bed space creation, securing accommodation, supporting tenants, supporting landlords, securing a return to accommodation after hospital/care stays, and budgeting support.  The BCF can be used for grants, repairs, preventative measures, early delivery schemes, heating, help for homelessness, and housing affordability for the elderly, families, singles, and rural inhabitants. 

The Good Homes Enquiry was touched on next; this involves Somerset Independence Plus, which has NHS England, local authorities, and ICS working with the BCF on housing and health matters.  Examples of flexible funding include prevention grants for independent living, assistive technology, work with hoarders, building independent assessment centres, helping young families with children who have behavioural issues, and energy efficiency (with respect to the last two issues, it was noted that there could be 100,000 children in care by 2025, while they have assisted over 8000 households to improve their energy efficiency and have also expanded the advice line and instituted decarbonisation training for local contractors).  These are a key part of delivering the Memorandum of Understanding on improving health and care through the home, and there is also a joint commissioning board working on these issues.

As regards the BCF moving forward, it was noted that the BCF is a very complicated endeavour; it is a big ask to have the Health and Wellbeing Board sign off retroactively on its very complex framework involving the collaboration of many different services.  The BCF is building on a strong reputation with a large number of joined up services and commissioning, but the focus going forward will be on out-of-hospital care and keeping people in their own homes (there are 7000 hospital discharges per month), so collaboration needs to be improved and other areas of integration and mutual interest could be included.  The question as regards the Health and Wellbeing Board and BCF is:  Should they engage with the HWB about the BCF and make this the main discussion point, or should they engage in a more meaningful way with the HWB about the areas of health and care that need to be brought together more as they move into the ICS, which could be of more value?  There are areas of care which are already jointly approached that are not allowed to be included in the BCF despite being very important, while there are other areas that are partly within the BCF but partly not for historical reasons; so they would like to move towards a larger, more comprehensive schedule of health and care that is jointly managed via engagement with the HWB.

The Director of Public Health stated that the presentation had been very helpful; she noted that there had not been massive growth in the BCF itself, but in the future she would like to see more of a "Better Prevention Fund", as there is a real need for the Health and Wellbeing Board to challenge inequality also through the BCF.   She stated that what we really need is people happily living independent lives, not needing care, so she would like to see a far great focus on prevention and particularly on keeping people out of care. She added that it as the Health and Wellbeing Board, it was necessary to challenge the use of all resources, including the BCF, around tacking inequalities, which appears to be missing in the national metrics at the moment.  Therefore, it needs to be built in at a local level.   It was replied that the way the schedule has now been constructed will help in having that conversation, as there will be a better understanding of where the funds are being spent and being able to shift them in that direction.  There are already quite a few preventative measures in the BCF, but there could be more, although the necessity of working with national metrics make that more of a challenge.  Hopefully, as a more vibrant ICS is formed, such conversations can be held.

The Chair thanked the presenters, although she noted that as a Board they would not be able to actually approve this as requested, due to not being quorate.

The Somerset Health and Wellbeing Board received and noted the report and the information.