Agenda item

To receive an update on the Better Care Fund Plan.

The Better Care Fund (BCF) Plan is a national programme to fund integration of health and cares services at a local level. In Haringey, it is underpinned through a £38m annual Section 75 agreement to pool funds between North Central London (NCL) ICB and London Borough of Haringey (LBH). The Department of Health & Social Care (DHSC) who run the BCF Programme requested each local area to submit a full Plan in June 2023 for the period 2023/24 and 2024/25.

Paul Allen and John Tomlinson from NHS Haringey CCG presented the Better Care Fund Plan 2023/24.

The following Points were noted in the discussion:

• It was noted that this report was delayed for the Council meeting last year.

• The report included a narrative, an investment schedule, and metrics for delivery.

• The report also encompassed Demand and Capacity analysis for Haringey’s intermediate care services.

• It was noted that the Health and Wellbeing Board's needed to approve the submitted Better Care Fund (BCF) Plan.

• BCF is a national program supporting health and social care integration for resident independence and improved outcomes.

• Haringey's BCF 23/24 aligns with the Borough Plan and supports the Ageing Well Strategy.

• The Plan was aimed to assure the Board of Haringey's commitment to health and social care integration.

• The national BCF requirements are for each Board to submit its Plan to the national BCF Team. The national BCF Policy Framework includes a joinlty agreed local plan signed off by the Health and Wellbeing Board, NHS Contribution to social care maintained in line with uplift to NHS (at 5.7%) and investment into NHS commissioned out-of-hospital services.

• Boards were required to submit Narrative and Excel spreadsheet outline of its plan. Implementing the BCF policy objectives such as enabling people to stay well, safe and independent and home for longer and provide the right care in the right place at the right time.

• Haringey’s investment schedule showed that the BCF plan was £38m investment in 2023/24 (£42M in 24/25) – nationally set level of minimum investment of which at least £7.7m needs to be on Adult Social Care related spend and £6.7m needs to be NHS commissioned out of hospital spend.

• There was also additional Funding for social care directly via Improved Better Care Fund (iBCF) and Disabled Facilities Grand (DFG’s). £2.4m Discharge Fund included in 2023/24 with £4.3m available in 2024/25.

• On the structure of the narrative, it was noted that there was a tiered approach to investment or the ‘Care Cone’, which is followed through of the BCF Plan, this starts with Healthy Safe and Well, Early Help, Severe/Complex and Specialist/Emergency at the top.

• The Plan addressed three key challenges, both locally and nationally:

• Firstly, the plan responded to the pandemic's legacy, managing increased cases of deteriorating underlying health. Secondly, to prepare out-of-hospital systems for heightened NHS Trust activity to ensure safe winter hospital discharge. Lastly, to tackle issues related to equity of access, outcomes, and experiences, especially in deprived areas within the Borough.

• The progress since 2022 was highlighted and this included:

• The successful distribution of 2,000 ‘Ageing Well Guide’ copies and provided training for 'age-friendly Haringey'.

• It was noted that there was an approximate 30% increase in GP consultations for older people, especially in deprived areas.

• MACCT received positive evaluation, reducing emergency admissions by 40%.

• There was a continued investment in out-of-hospital services, with 93% of patients discharged home.

• Supported 'Home First' with 1,350 reablement episodes.

• Experienced a 64% increase in monthly patients accessing Rapid Response service.

• Achieved a one-third reduction in emergency admissions of Haringey patients aged 65+ between 2019/20 and 2022/23, with increased multi-morbidity.

• Some of the new or expanded investments in 2023/24 included:

• Continued investment in Early Help and Prevention. Investment in bereavement services for carers of individuals with terminal conditions. Expansion of community health services to support medium to long-term care needs, assisting Whittington Health colleagues with community self-referrals.

• Also, the Inclusion of ICB Wheelchair Services in the BCF plan scope. Continued investment in intermediate care services and support for those in challenging housing environments through the discharge fund. John Updated the Board on the Carers Support Network, with efforts to co-produce necessary services and update the Carers Strategy, including investments of an extra £400,000 in carer services.

• Collaboration among NCL Councils and ICB to refresh the 2024/25 BCF Plan and Discharge Fund arrangements in Q4 2023/24.

• It was noted that there was work was underway in NCL ICB to determine local needs, compare them with other boroughs, and allocate resources, accordingly, spanning beyond just community health. This work will be shared with Councillors to get their views and ascertain how to deliver services differently and innovate.

• The NCL ICB assessed local needs, compared them with other boroughs, and allocated resources beyond community health. They involved Councillors to gather views on service delivery and innovation.

• The Better Care Fund's effectiveness for reablement was questioned. It was explained ongoing work to assess needs across boroughs and allocate resources accordingly, beyond just community health.

• The collaborative efforts with carers groups to co-produce tailored services was emphasised, with positive feedback indicating successful initiatives. An extra £400k investment was announced to support carers, reflecting shared responsibility among partners beyond the council.

• There was recognition for the need to improve discharge coordination, noting it as a broader challenge across the public sector, not just unique to Central London.

• The Chair raised and expressed satisfaction over the increase in older people's GP consultations and raised concerns around the utilisation rate of the Ageing Well Guide among professionals working with older individuals. Broader concerns were voiced regarding the adequacy of community services, given the increasing pressures on the NHS and evolving patient needs upon discharge.

• John Poulter, a member of the public, raised concerns about improving pre-surgery procedures to prevent cancellations, based on personal experiences.

• Beverly Tarka, Director of Adults, Health & Communities, highlighted issues related to discharge procedures and emphasised the importance of supporting carers within the system.

• There was discussion regarding the use of agency workers versus paid carers.

• There were ongoing efforts to understand resource allocation and distribution, as well as initiatives to enhance service delivery through co-production and community engagement.

• Concerns were raised regarding the implementation of co-production initiatives, Sharon Grant emphasised the need for genuine consultation and community involvement.

• The Chair addressed and stressed the importance of a continued dialogue and collaboration.

• The NHS's evolving approach towards co-production was acknowledged with the promising initiatives aimed at addressing inequalities.

RESOLVED:

The Health and Wellbeing Board resolved:

1. To note the year end summary for the Haringey Better Care Fund (BCF) Plan Narrative for 2021/22 (Appendix 1).

2. To confirm the Plan meets national BCF Plan Conditions discussed for 2023/24 and 2024/25, and to note, however, that details in the latter year’s Plan will need to be resubmitted to the Board as part of a national and local update in the latter half of 2023/24.

3. To endorse the BCF Plan submission for 2023-25:

• The updated Haringey BCF Plan Narrative (Appendix 2);

• The BCF National Funding Template for Haringey with an investment schedule and trajectories for BCF metrics, plus a demand & capacity analysis associated with Haringey’s intermediate care services in 2023/24 (Appendix 3). The funding schedule in Appendix 3 includes additional Discharge Fund investments that assure the availability of the stated service capacity in 2023/24.

• The BCF Plan Q2 update for Haringey is included in Appendix 4.