London Better Care Fund Programme Overview

1. London Better Care Fund
programme overview
1
HIA Network briefing February 2020

2. 3. Better Care Fund Overview
4. How BCF is spent in London
5. BCF metrics London overview
6. Planning requirements relating to DFG
7. Future of the BCF: 2020-21 and beyond
Contents

3. Better Care Fund Overview
The Better Care Fund (BCF) is the first and only national policy
in England that is mandated to support health and social care
systems to provide more integrated, person-centred care.
• Partnership programme between NHS, LGA, DHSC and
MHCLG
• Aims to break down organisational barriers so health,
housing and social care can deliver the right care, in the
right place, at the right time.
• From the point of view of the individual -“I can plan my
care with people who work together to understand me
and my carer(s), allow me control, and bring together
services to achieve the outcomes important to me.”
• In 2018-19 year end return,
• 93% of Health & Wellbeing Boards endorsed the
statement that the “Delivery of the BCF has improved
joint working between health and social care in our
locality” and
• 90% that “Delivery of our BCF plan had a positive
impact on the integration of health and social care in
our locality”
• Increasing focus on Housing as one of the key pillars for
integration 3
£67m
£299m
£37m
£201m
£605m
£103m
LA - DFG,
£66,621,394, 5%
LA - IBCF,
£299,077,746,
23%
LA - Winter,
£37,170,352, 3%
LA- additional,
£200,733,617,
15%
CCG minimum,
£605,278,544,
46%
CCG Additional,
£102,686,525,
8%
London Pooled BCF 2019-20 (£1.3bn)
*CCG minimum required spend on social care: £256m
*CCG minimum required spend out of hospital: £172m

4. How BCF is spent in London
 A significant proportion of planned schemes are
integrated approaches, with an “interface” between Health
and Social care.
 In London, the top five areas of spend are:
• Residential Placements – 20%
• Community Based Schemes – 14%
• Integrated Care Planning – 12%
• Domiciliary care at home – 11%
• Intermediate Care Services – 10%
(Important to note that this does not represent all community
spend in these categories, as not all will be pooled within the
BCF)
 DFG related schemes makes up 5% of the total BCF
budget. Assistive technology and equipment was 3% and
Housing related Schemes 1%
4
£9,332,939
£9,862,188
£21,601,470
£26,827,407
£30,812,960
£34,287,441
£36,441,846
£42,425,820
£63,775,947
£64,303,454
£90,504,731
£130,953,687
£144,601,025
£153,054,157
£189,296,881
£263,486,222
£0 £100,000,000 £200,000,000 £300,000,000
Other
Housing Related Schemes
Carers Services
Personalised Budgeting and…
Enablers for Integration
Assistive Technologies and Equipment
Prevention / Early Intervention
Care Act Implementation Related Duties
Personalised Care at Home
DFG Related Schemes
HICM for Managing Transfer of Care
Intermediate Care Services
Home Care or Domiciliary Care
Integrated Care Planning and Navigation
Community Based Schemes
Residential Placements
2019-20 BCF Scheme spend categorized by types of schemes
Some London examples of BCF schemes
• Camden - Crisis House Mental Health Service – providing crisis accommodation for people with mental health needs, as an alternative to hospital admissions
and complements existing inpatient and home treatment services.
• Hackney – Age UK Take Home & Settle service is aimed at patients within the Homerton who need practical and emotional support upon discharge. The service will
act as a gateway signposting and referring to community services and support with the aim of enabling patients to remain independent at home wherever possible.
• Hillingdon – Brought together multiple contracts for therapy services for children and young people, into one this year, under the existing BCF Section 75 contract.
This broadening the scope of their BCF, and seeking to make the support more joined up and proactive.
• Merton - Use of the Winter Pressures Grant to support the NHS – winter handyperson scheme, short term accommodation for street homeless, increasing capacity in
social care staffing in hospital and additional packages of care and care home beds
• Southwark – A housing officer working with hospital discharge teams to help avoid housing related delays - newly started, with positive impacts already being seen

5. BCF metrics London overview
1) Leadership & Vision
Non Elective Admissions Delayed Transfers of Care
Reablement
(proportion of older people still at home 91
days after discharge)
Residential Admissions
(rate by 100,000 people over 65)
Note:
• National data only available annually.
• Higher percentage of Reablement is better performance
• London performs well against comparators
Note:
• National data only available annually.
• Fewer residential admissions is better performance
• London performs well against comparators
Note:
• Unit: NEA rate per 100k population (unadjusted,
all ages)
5
611
580
560
570
580
590
600
610
620
2016-17 2017-18 2018-19
2018-192018-19
82.5% 82.4%
81.0%
81.5%
82.0%
82.5%
83.0%
83.5%
84.0%
2016-17 2017-18 2018-19
0.0
100.0
200.0
300.0
400.0
500.0
600.0
Apr-13
Nov-13
Jun-14
Jan-15
Aug-15
Mar-16
Oct-16
May-17
Dec-17
Jul-18
Feb-19
Sep-19
London DTOCs on a day
National DTOC ambitions
set through BCF, including
High Impact Change Model
• London Non Elective Admissions are rising. As at the latest validated data position, London’s NEAs were at 72,474, compared to its target of 70,391, a 15%
growth since April 2017
• London DTOCs in November - 459 bed days lost, with 47 days (11.4%) above the regional ambition of 412. DTOCs starting to fall again. London 6.7 days per
100k population with England at 11.2 days. Improvement between Nov (459) and Oct (498) of 39 days
• Reablement (proportion of older people still at home 91 days after discharge) – London has better performance than other regions
• Permanent Residential Admissions – London has better performance than other regions
56000
58000
60000
62000
64000
66000
68000
70000
72000
74000
76000
Apr-17
Jul-17
Oct-17
Jan-18
Apr-18
Jul-18
Oct-18
Jan-19
Apr-19
Jul-19
Oct-19
London Non Elective Admissions

6. Change 9: Housing and related services
Scope
• Systematic response, and demand/capacity planning
• Early needs assessment and response
• Integration and joint working
• Home adaptations, equipment, telehealth and telecare
• Homelessness and duty to refer
Effective referral processes and good services which maximise independence are in place
to support people who have no home, or cannot go straight home. The need for safe and
accessible housing, housing and related support services, home adaptations and
equipment are recognised early in discharge planning and readily available when needed.

7. Change 9: Housing and related services
Key points
• Early discharge planning includes a person’s housing situation or needs
• Include housing/housing service provider(s) as real or virtual member(s) of
your discharge planning team.
• Fix it now
• Inform your workforce – educate them about options, beyond aids and
adaptations
• Homelessness should not be a reason for delaying discharge
• Consider the role of the voluntary, community and social enterprise sector
in support people to get home, and access support in their community
• Short-term accommodation, such as step-down, can be appropriate where
a person is ready to go home but their home is not ready
• Use data to understand demand for, and capacity of housing services

8. BCF Planning requirements relating to DFG
8
…in 2018-19:
In all areas, is there a plan for DFG spending? And, in two tier areas, has the DFG funding been passed
down by the county to the districts (in full, unless jointly agreed to do otherwise)?
2019-20
Is there confirmation that use of DFG has been agreed with housing authorities?
• Does the narrative set out a strategic approach to using housing support, including use of DFG funding
that supports independence at home.
• In two tier areas, has:
• Agreement been reached on the amount of DFG funding to be passed to district councils to cover
statutory Disabled Facilities Grants? or
• The funding been passed in its entirety to district councils?
Expenditure plan, “source of funding” category

9. Future of the BCF: 2020-21 and beyond
Focussing on
personalisation and
better outcomes
for people
Dept. consensus on the
importance of joint
working between
health and care sectors.
Greater focus on aligning
health and social care
systems priorities
Review of the BCF 2015-
2020 has built on the
vision of the NHS LTP
9
BCF confirmed
for 2020-21
Planning Requirements
expected to be published in
February 2020 (referenced
in CCG operating guidance)
Local Government Finance
Settlement confirmed some
Local Government aspects
of the pooled funds –
Improved BCF and Winter
Pressures Grant to be as
2019-20.
CCG minimums to be
confirmed in CCG operating
plan guidance – with LTP
growth of 5.3%
Disabled Facilities Grant not
yet announced. Expecting
this before February
publishing of Planning
Requirements.
Beyond 2020-21