The document provides an overview of the Better Care Fund (BCF) program in the UK, which brings together health and social care funding. It discusses how the Disabled Facilities Grant (DFG) is an integral part of delivering BCF plans by funding home adaptations. The main changes for 2017-2019 include a two-year planning cycle, reduced national conditions, and increased funding contributions. Examples are given of how the DFG has been used through the BCF to fund home adaptations that support independent living and reduce hospital admissions.

1. The Better Care Fund
Disabled Facilities Grant: an integral part of delivering
Better Care Fund plans
Integration and Better Care Fund
2017-2019
In support of Foundations Roadshows
April/ May 2017

2. Agenda
• Overview of the Better Care Fund programme
• Housing, social care & health
• Better Care Fund: Disabled Facilities Grant
• Main changes, 2017-19
• Any questions?

3. Overview of the Better Care Fund
• The Better Care Fund (BCF) is the only mandatory policy to facilitate integration. It
brings together health and social care funding, with a major injection of social care
money announced at Spring Budget 2017.
• Established in 2013 to help accelerate local integration of health and care service to
deliver outcome for patients and service users.
• Seeks joined-up health and care service so that people can manage their own health
and well being.
• Patients and service users can live independently in their communities for as long as
possible.
• A sustainable and effective health care system, relieving pressure on acute services.
• This time the policy framework for the Fund covers two financial years to align with NHS
planning timetables and to give areas the opportunity to plan more strategically.

4. Main changesBigpicture
• More on
integration
• Two year
planning cycle
2017-19
• Invitation to join
first wave of
graduating
areas
• New grant to
LAs for social
care –
Improved Better
Care Fund
Changestoconditions
• Reduction in
number of
national
conditions, they
are:
o Jointly agreed
plan
o Social care
maintenance
o NHS
commissioned
out of hospital
services
o Managing
transfers of
care
Metrics
• Remain the
same as 2016 –
17:
o Non-elective
admissions
o Admission to
residential care
homes
o Effectiveness
of reablement
o DToCs.
• No local metric
will be collected
centrally
Metrics

5. Main changes – national conditions
• Jointly agreed plans
• Maintain social care
• 7 day services
• Better data sharing
• Joint approach to
assessment and care
planning
• Agreement on impact on
providers
• Invest in NHS
Commissioned Out of
Hospital services
• Action plan on Delayed
Transfers of Care (DToCs)
• Jointly agreed plans
• Maintain NHS contribution
to adult social care in line
with inflation
• Invest in NHS
commissioned Out of
Hospitals services
• Manage transfers of care
2016/17
2017-19

6. Main points – Funding contributions for next
two years (millions)
• Uprated in line with CCG allocations in both 2017/18 and 2018/19
• Will continue to be pooled.
• Paid to LAs from 2017/18
• Complements precept – focussed on areas with lower council tax
base.
• Includes new money in spring budget 2017.
• Subject to grant conditions set by the Department for Communities
and Local Government (DCLG).
• Paid to local authorities (LAs) as in 2016/17 subject to grant conditions.
• Specified requirements in Two tier areas are required to pass Disabled
Facilities Grant (DFG) to districts (unless there has been specific
agreement).
• To be spent on statutory duties to provide adaptations and strategic work
join up health, care and housing.
Disabled
Facilities
Grant
£431 (2017/18)
£468 (2018/19)
CCG
minimum
£3,582 (2017/18)
£3,650 (2018/19)
Improved
Better Care
Fund
£1,115 (2017/18)
£1,499 (2018/19)

7. Planning overview
Vision for health
and social care
integration
Plan, with
supporting
evidence
Assessment of,
and approach to,
risk.
National
conditions
narrative
Planning
Template
Confirmation of
funding
contributions
Detail of
schemes
Confirmation of
national
conditions 2, 3
and 4
National Metrics
Supporting
documents
Links where
relevant to plan.
Can include:
Joint Strategic
Needs
Assessment
Social Care
Market Position
Statements
Corporate risk
registers
Narrative
Plan

8. Disabled Facilities Grant
Regulatory Reform Order (RRO 2002)
All LAs have the power under the RRO to spend the DFG monies
in a wider more preventative manner under the auspices of the
RRO.
This means that the grant can be used more flexibly than under
the mandatory criteria so can include:
• Hospital Discharge Grants
• Handyperson Services
• Heating and other repair issues
• Relocation grants for people that need to move rather than
adapt
“The increase in funding for the DFG – and the decision to move
it into the BCF in 2015-16 – is recognised as an important step in
the right direction.” - Integration and BCF Policy Framework,
March 2017

9. Better Care Fund: Disabled Facilities Grant
National conditions 2017-19 of access to the Better Care Fund
National condition 1: Plans to be jointly agreed
(As published in the Integration and Better Care Fund Policy Framework, March 2017)
• Local areas must ensure that their Better Care Fund (BCF) Plan covers the minimum of the pooled fund specified
in the BCF allocations spreadsheet, and potentially extending to the totality of the health and care spend in the
Health and Wellbeing Board area.
• The plans should be signed off by the Health and Wellbeing Board itself, and by the constituent councils and
Clinical Commissioning Groups.
• The DFG will again be allocated through the BCF. As such, areas are required to involve local housing authority
representatives in developing and agreeing the plan, in order to ensure a joined-up approach to improving
outcomes across health, social care and housing.
• In two-tier areas decisions around the use of the DFG funding will need to be made with the direct involvement of
both tiers working jointly to support integration ambitions. DFG funding allocated by central government should
be passed down by the county to the districts (in full, unless jointly agreed to do otherwise) to enable them to
continue to meet their statutory duty to provide adaptations and in line with these plans. During these
discussions, it will be important to continue to meet local needs for aids and adaptations, whilst also considering
how adaptation delivery systems can help meet wider objectives around integration.
• For both single tier and two tier authorities, areas are required to set out in their plans how the DFG funding will
be used over the two years.
• In agreeing the plan, Clinical Commissioning Groups and local authorities should engage with groups likely to be
affected by the use of the fund (including health and social care providers) in order to achieve the best outcomes
for local people.

10. Housing, social care and health

11. Growing recognition of the role of housing
Select Committee: Adult Social Care (March 2017)
• The Chartered Institute for Housing: anecdotally there is still variable involvement and integration of
local housing authorities particularly in two tier areas, in the development of health and wellbeing
strategies and action plans to support the BCF.
• Concern that DFG was “…a slow, costly and frustrating process”.
• Recommendation by Adult Social Care Select Committee: DCLG should review the operation of the
DFG especially the split between districts and county councils and housing and social care in
unitary authorities.
• Range of NHS England Quick Guides targeted at CCGs – Foundations and Better Care Support
have been engaged
• Building awareness that housing organisations can: provide health and wellbeing services; improve
homes; improve safety and suitability; provide step up and down services; and offer advice.
• This quick guide focuses on three key elements:
1. How housing can help prevent people from being admitted to hospital;
2. How housing can help people be discharged from hospital; and
3. How housing can support people to remain independent in the community
http://www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/Quick-Guide-health-and-
housing.pdf
NHS Quick Guides

12. Oxford - Mears Home Improvement
Action
The Mears Health Improvement Agency (HIA) accessed several funding streams to
support the service user including, the DFG, Home Repairs Assistance; and Better
Homes, Better Health (BHBH).
The service user was initially referred to the HIA for a stair lift installation under the
DFG. On completion of the stair lift, the carer informed the HIA of a leak in the
ceiling in the back room. The Caseworker requested a BHBH assessment from the
LA and successfully applied for funding from two other funding streams, in order to
satisfy the decent home standard which covered:
• Installation of four night storage heaters
• Repairs to the roof which caused the leak
The caseworker also successful applied for Attendance Allowance and Pension
Credit for the service user.
Aims and
Objectives
This case study outlines how the DFG, which is part of the BCF, has helped to meet
the needs of a service user by improving their living environment to one that is
considered safe and healthy, and in turn will reduce the risk of hospital admissions.
The service user's home was successfully brought up to a ‘decent home’ standard
which promotes improved health and wellbeing for the service user. The lessons
learned from this case illustrated that the HIAs holistic approach and gentle nature
need to be promoted, as this helped to understand the service user’s wider needs
and enabled a join-up approach to care and support services beyond the DFG.
Result and
lessons
learnt

13. Dorset – Dorset Accessible Homes Service
Action
Health colleagues placed an urgent referral through the Home Improvement Agency (HIA) in
order to request rapid completion of necessary home adaption works.
Aims and
Objectives
Enabling a terminally ill patient to return home safely during her final months. Her deteriorating
medical condition of lung cancer and chronic arthritis meant that she was unable to return to her
property without it be adapted and during the coordination of work would need to remain
hospitalised.
From receiving the referral, she was visited in hospital, necessary permissions from the
property owner were obtained and all forms were completed. The grant application was
submitted for grant approval with Dorset County Council and approved all in the same day.
Within 4 days from referral, a recycled and reconditioned stair lift was installed which enabled
her safe discharge from hospital to return home for her end of life. Funded by Dorset County
Council, DFG.
The service delivery was enabled through a collaborative approach between Dorset County
Council, District partnership (housing authority) and Millbrook Healthcare.
The 1st October 2016 brought about a change to grant admission following a root and branch
review of DFG administration. The introduction of an up to £5,000 non means tested grant and
the HIA provider (Millbrook Healthcare) grant service delivery model has reduced the length of
time required to administer a grant within Dorset.
The client described within the case study, was a beneficiary of a whole systems review. The
wider benefit realisation both ethically and cost avoidance is also visible.
Result and
lessons
learnt

14. Croydon - Staying Put
Action
Through the intervention of a neighbour (whose property was being affected by a leak), the property was
finally transferred into the client’s name. This enabled us to be able to offer him an interest only loan to
undertake major repairs, roof, windows, electrics and staircase. During the same period the client was
admitted to hospital in Cardiff but was later transferred back to a local hospital. He needed a wheelchair to
mobilise outside of his home, but as a result of this episode, his condition deteriorated and he became a
full time wheelchair user. As a result, his requirements changed and he needed adaptations to the
property to enable ground floor living, with a level access shower, bedroom, useable kitchen and an
external ramp to provide wheelchair access to the property. Though he was fit for discharge his property
was not habitable. He was transferred into wheelchair accessible temporary accommodation, where he
remained for four months whilst the work was being carried out in his home.
The agency’s Caseworker in conjunction with the surveyors arranged a programme of work to include the
renovation work through the council’s Interest Only Loan, an Energy Loan for central heating, Major
Adaptations for a level access shower and wheelchair accessible kitchenette, and front ramp funded
through the DFG. The property was also badly cluttered with years of hoarding, the Reablement funding
from the BCF enabled us to clear the property prior to work starting and funded non slip flooring to the
kitchen/bedroom as well as a new bed.
Aims and
Objectives
In order to facilitate the safe discharge of a long-term hospital patient, a number of major repairs and
adaptations were required to be made to the patient’s home to improve accessibility and prevent injury.
The client had been known to the Croydon Staying Put Home Improvement Agency for a number of years
as the property was in a poor condition and required major renovation. Unfortunately the property was in
his deceased mothers’ name, and he did not have the funds or ability to transfer the ownership.
The success of this case was joint working with the caseworker, occupational therapist, surveyors, and
other health care professionals. It required the expertise of the HIA to co-ordinate and manage various
streams of work and funding sources required to ensure a programme of work and assistance that would
result in the client returning home to with full wheelchair access to the kitchen, bathroom and bedroom/
living room. The client is now able to live independently, with a minor care package from social services.
Result and
lessons
learnt

15. Ealing – Home adaptations service
Action
As well as streamlining their DFG process, they have developed an innovative handyperson
service and a fast-track scheme for equipment, including stair lifts.
Aims and
Objectives
Ealing Repairs & Adaptations is an in-house agency in the London Borough of Ealing.
Consistent standard of service delivery to everyone in the Borough.
DFG in15/16 was £2.825m – £1.325m from national government (paid via the BCF), and
£1.5m from the LA.
Referrals are accepted from internal departments in the council, as well as from voluntary
sector organisations and hospitals.
If a family is on benefits, they can get an interest-free loan to pay their contribution over the
DFG limit.
Innovative use of a handyperson service – for minor works/adaptations – to help with hospital
discharge and reablement for elderly, disabled or otherwise vulnerable people.
A Fast-track process for stair lifts, which are non means-tested and fitted quickly and
effectively
“The Regulatory Reform Order allows us to be flexible with how we use the funding. We need
to deliver as quickly as possible, at the right price, and give a good customer experience…
Integration with health and social care is making a real difference. One of the best things that
has happened is moving the DFG funding into the Better Care Fund.”
Result and
lessons
learnt

16. Examples of DFG in Better Care Fund
• To be able to demonstrate the value of home adaptions, the contribution they make to reducing health
and care costs and keeping people independent in their own homes.
• Capture the large amount of preventative, additional adaption work undertaken falling outside the
DFG, including those individuals self-funding.
• MOU between Lincolnshire County Council and its District Councils where both have agreed to
develop an Integrated System of Housing for Independence across Lincolnshire with the key aims.
Lincolnshire County Council
North Yorkshire County Council/Scarborough and Ryedale District Councils
• Faster more streamlined service using IPad technology.
• Worked with social care and health to integrate services especially by way of web based referrals.
• Worked with North Yorkshire County Council to develop energy efficiency and to shape Winter
Health Strategy.
• Three districts jointly funding work with Family Mosaic: a full time Health & Housing Co-ordinator
and enhanced handyperson scheme as part of Integrated Discharge scheme
• Dartford and Sevenoaks councils also exploring Hospital Discharge scheme
Supporting Hospital Discharge - Pilots in Kent

17. The Better Care Fund
Any questions?
For more information contact us at
England.bettercaresupport@nhs.net