Agenda item

To consider a presentation on the Better Care Fund (BCF) in Cheshire East

Louisa Ingham, Senior Accountant, and Caroline Baines, Commissioning Manager for BCF, provided a briefing on the Better Care Fund (BCF). The presentation informed the Committee about the national context for the BCF and how it was being managed in Cheshire East. The presentation also provided a brief overview of the schemes that were being funded by the BCF. During the presentation the following points arose:

·         The BCF was introduced by Government to encourage integration and coordination of health and adult social care services across the NHS and local authorities. Pressure on services caused by an ageing population with increasingly complex needs and reduce budgets meant new ways of working needed to be developed.

·         Nationally the BCF was £3.8bn taken from existing health and social care budgets and was implemented in April 2015. Locally £23.9m from Eastern Cheshire Clinical Commissioning Group (CCG), South Cheshire CCG and the Council was but into two separate pooled budgets covering the two CCG areas.

·         National conditions were set for the improvement of outcomes influenced by the BCF including a 3.5% reduction in non elective admissions to hospital, better data sharing and seven day per week services. Achievement of these conditions were linked to a performance fund which was a proportion of the BCF budget set aside for further investment if the conditions were achieved. If conditions were not achieved the fund would be directed to acute (hospital) services.

·         The Health and Wellbeing Board was responsible for monitoring the performance of the BCF and had to report to NHS England on a quarterly basis. A BCF Governance Group had been set up to monitor the delivery of the BCF plan, including management of risk.

·         There were 12 schemes in Cheshire East, nine of which were shared schemes led by the Council. Some of the schemes were only part funded by the BCF and were mostly funded by internal budgets at the Council or CCGs. BCF accounted for 3% of all spending by the Council and the CCGs.

Members of the Council’s Audit and Governance Committee attended the meeting to take part in this item jointly with the Committee as the BCF had also been an item of interest in their work programme. Members asked questions and the following points arose:

·         It was questioned whether any areas in England would be able to achieve 3.5% reduction in non elective admissions to acute services. Locally their had been some improvements during the first quarter and Wirral had reported promising results so far. The impact on the number of non elective admissions may not have been felt until 2016/17 when schemes had been fully implemented.

·         The budget for BCF had been taken out of existing CCG and Council budgets meaning that the budget to fund for acute services had been reduced. Acute services would have been under pressure to continue to deal with existing levels of demand with reduced budgets while BCF schemes were being put in place and starting to make an impact on admissions. The resilience of acute services was being monitored during this period. If the 3.5% reduction in admission wasn’t achieved the £2.1m performance fund would be given to acute services to mitigate the excess demand.

·         Members requested that the terms of reference for the BCF Governance Group be shared and that there activities were transparent through the Health and Wellbeing Board.

·         A risk register was held for the BCF and each scheme manager was expected to monitor risks. High level risks were escalated through the Council and CCG leadership.

RESOLVED

(a)  That the presentation on the BCF be noted

(b)  That the Committee requests for the terms of reference for the BCF Governance Group be shared with councillors

(c)  That the Committee will monitor the reporting of the Better Care Fund to the Health and Wellbeing Board and may request an update on performance at a future meeting of the Committee

The Chairman adjourned the meeting for a five minute recess. The visiting members of the Audit and Governance Committee left the meeting.