Meeting documents

To receive the reports and presentation.

The Health and Wellbeing Board & Integrated Care Partnership:

·       Noted the outturn report for 2021/22

·       Signed off the Better Care Fund plan for 2022/23

·       Discussed opportunities for future plans

The Chair invited Denise D’Souza, Interim Director/Assistant Director ASC Commissioning, to make the presentation, supported by Paul Coles, Strategic Manager Adult Services, and Alison Roswell of NHS Somerset.  It was noted that this would be a brief introduction to what the Better Care Fund is and the role of the HWB in signing off the 2021 outturn and 2022-23 plan, as well as being a discussion about the opportunities for developing the 2023 plan. 

What is the BCF

The Better Care Fund began in 2013 as a way of pooling budgets, directing funding to adult social care, and providing a mechanism to support integration and system working with partners.  There is a pool budget under Section 75, which is a formal agreement; within that pool budget is funding to protect adult social care.  The principles adhered to, which have not significantly changed, are the right care at the right place at the right time, with people supported to stay safe and independent in their homes for as long as possible.

Financial Details - 2022-23 Plan

The total pooled fund is just under £74 million, with the majority of the spend to support Disabled Facilities (£4.9m), Adult Social Care services (£24m), Intermediate Care services (£30m), and the voluntary/community sector (£9m).

Challenges – Because guidance often comes out very late in the year, plans have often rolled over, especially due to Covid.  We have to produce an outturn plan for last year, which has to be signed off by the HWBB.  As for this year, the guidance only came out around August, but the plan was to have been submitted by September; that is now going through a governance process, although the plans are about to be signed off.  So the HWBB is required to sign off both the outturn and the plan.  Somerset is like no other authority in that this is always retrospective, which provides one of the challenges. 

Opportunities – There will be another BCF process next year, and there will be a two-year plan.  It was currently being considered if the process should begin before receiving the guidance, or if the process should await receipt of the guidance.  It is known more or less what will be contained in the guidance, since the metrics that have been used for the last four years likely have not changed much with respect to admission avoidance, discharge to the usual place of resident, residential admission, and reablement.

Narrative Plan

As well as the key metrics, it is necessary to submit our plans for the use of the Disabled Facilities Grant, support to informal carers, health inequalities, and integration of systems and services.

Next Steps – 2023 Onward

The plan, which will be developed by working with partners, will reflect the work underway and future aspirations, ensure that the appropriate governance structure is in place to monitor plans and performance, and consider how the HWB will be involved.  Both plans have already been signed off by the NHS.

The Chair then invited Board members to discuss the presentation and raise questions, particularly regarding the budget, given that there is a substantial amount of money involved; and he welcomed the transparency in the report regarding how the money will be spent and how it will help different partners.  Mel Lock, Lead Commissioner Adults and Health, stated that some of this funding is part of the bottom line for their budget for social care, and beyond that, discussion is needed on how to use the funds to meet their needs, especially given the extensive guidance from the NHS on how it can and cannot be spent.  A workshop could be held to discuss linking the budget with the strategy and the need to move funding from one place to another. 

Jai Vick, Head of Housing Services at Mendip District Council, stated that District housing teams have been innovative with BFC and DFG funding in undertaking proactive improvements, so they and their private sector housing colleagues would like to ensure that they are involved in these discussions and involved with the DFGs and making improvements to housing, not just as regards crisis and intervention services but also proactive measures.

Jonathan Higman, ICB Chief Executive, noted that this was a massive opportunity that will be an enabler for delivering the strategy, with examples being the hospital discharge scheme and improvement of intermediate care services. 

Lou Woolway, Deputy Director of Public Health, emphasised that it is the statutory function of the HWB to have oversight of the BCF, and this needs to be true oversight.  A workshop could be held to develop this and to consider all decisions that the Board makes, including housing.  Denise D’Souza, Interim Director/Assistant Director ASC Commissioning, reminded that DFG is ring-fenced within the BCF for prescribed items and protecting adult social care. 

Cllr Chilcott offered that there will be many statutory delivery items within the BCF, but there is also much potential for delivering the strategy by doing things better and improving outcomes.  Initially, this may not be possible to a great extent, given the huge budgetary pressures, the place to start is with prevention, keeping people out of hospital, and keeping them fit for longer.  She welcomes the clarity around what the BCF funding is doing for residents around Somerset.

Peter Lewis, Somerset Foundation Trust CEO, noted that there was an opportunity here that they had not historically taken, so now was the best time to do so. 

Cllr Wyke asserted that the prevention agenda is critical across the strategy, and the BFC could be the way to deliver it. 

Lee Howell of Devon and Somerset Fire and Rescue observed that this funding is for a range of services, but there is a need to consider other services like fire and rescue.  An awareness of all activities is needed in order to align all activities and add value through what is already being done.

Katherine Nolan, SPARK Somerset CEO, said it was heartening to see £9 million allocated for the voluntary sector, and she agreed that discussions about new funding need to link with what is already being done, such as the more than 60 warm spaces that have been set up and other work in the communities.

The Chair stated that it was a classic moment for working together to use funds wisely, that the prevention agenda was fundamental, and that the transparency with respect to the effective use of funds was fantastic.

The recommendation was that the Health and Wellbeing Board & Integrated Care Partnership:

·       Note the outturn report for 2021/22

·       Sign off the Better Care Fund plan for 2022/23

·       Discuss opportunities for future plans

The Board approved these recommendations.