Nottinghamshire Better Care Fund (BCF) Plan 24 February 2016

Transcription

1 RCCG/GB/16/037 Nottinghamshire Better Care Fund (BCF) Plan 24 February 2016 The Comprehensive Spending Review (25 November 2015), confirmed that the BCF will continue into with a mandated minimum of 3.9 billion to be deployed locally on health and social care through pooled budget arrangements between local authorities and Clinical Commissioning Groups. We are awaiting the publication of detailed planning guidance, templates and timescales, but anticipate that the BCF plan will include the following elements: Narrative plan and BCF national conditions Confirmation of funding contributions and scheme level spending plan National metrics The timescales for submitting BCF local plans will follow the deadlines set out in the NHS Planning Guidance currently indicated as: 2 March: Local areas to submit the completed BCF Planning Return template including funding contributions, a scheme level spending plan, national metric plans, and any local risk sharing agreement. 21 March: First submission of full narrative plans for Better Care alongside a second submission of the BCF Planning Return template. 25 April: Final submission, once formally signed off by the Health and Wellbeing Board. The Nottinghamshire Health and Wellbeing Board is accountable for the Nottinghamshire BCF plan, and will be considering the BCF 2016/17 plan for approval on 6 April. Constituent Clinical Commissioning Groups and District Councils are requested to approve the Nottinghamshire BCF 2016/17 plan on behalf of their organisation by 24 March (a named signatory will be required), and delegate the approval of any amendments to the countywide plan (made at the Health and Wellbeing Board, or through the assurance process) to either: The Health and Wellbeing Board A named officer and / or member within your organisation In summary, the BCF plan contains the following elements Narrative Plan BCF Policy Guidance for 2016/17 was published 11 January 2016 ( work_ pdf ). Updated narrative is needed for each element of the narrative BCF plan, which includes: 1. The local vision for health and social care services 2. An evidence base supporting the case for change 3. A coordinated and integrated plan of action for delivering that change 4. A clear articulation of how they plan to meet each national condition 5. An agreed approach to financial risk sharing and contingency The national conditions outlined in the guidance are as follows: National Condition New / Revised Requirement Implications 1. Plans to be jointly agreed Revised requirement for local authority housing colleagues to be involved in developing and agreeing plans. CCGs and District Councils to agree the BCF plan through their own governance structure by 24 th March 1 P a g e

2 National Condition New / Revised Requirement Implications 2. Maintain provision of social Contribution nationally mandated. care services 3. Agreement for the delivery of 7-day services across health and social care to prevent unnecessary non-elective (physical and mental health) admissions to acute settings and to facilitate transfer to alternative care settings when clinically appropriate. 4. Better data sharing between health and social care, based on the NHS number 5. Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an accountable professional Revised requirement for dementia services to be a particular priority. Narrative includes local dementia services both within and outside of the BCF plan. 6. Agreement on the consequential impact of the changes on the providers that are predicted to be substantially affected by the plans 7. Agreement to invest in NHS commissioned out of hospital services, which may include a wide range of services including social care 8. Agreement on local action plan to reduce delayed transfers of care (DTOC) 2 P a g e requirement for completion of Annex 2 TBC Revised requirement. Pay for Performance will not be included in the plan as in 2015/16 but we will have to demonstrate how the 1bn nationally previously for Pay for Performance will support NHS commissioned out of hospital services including social care. New requirement Funding contributions and scheme level spending plan Risk share discussed at BCF Programme Board- decision not to progress. Minimum contributions have been nationally mandated. Finance leads have identified schemes within the BCF plan which meet this requirement the minimum contribution has been exceeded. Risk share discussed at BCF Programme Board- decision not to progress. Countywide action plan developed for submission with the BCF plan. BCF allocations were published 8 February On 22 January 2016 an extended BCF Programme Board meeting was held with partners to review our BCF plan using the Better Care Support Team selfassessment tool. There was good engagement in the event and a number of successes and areas for action during 2016/17 have been identified. Having reviewed BCF schemes as part of the evaluation process, there are no material changes to schemes / services within the Nottinghamshire BCF 2016/17 plan. However some schemes have been refocused in light of emerging priorities and changes within the Nottinghamshire planning footprint, for example, since BCF planning in 2014, Nottinghamshire has been awarded Vanguard status in a number of areas (Mid Nottinghamshire Better Together PACS, Principia Partners in Health MCP, Greater Nottingham

3 Urgent and Emergency Care, East Midlands Radiology Consortium, Primary Care Homes model in Nottingham North East and Bassetlaw CCGs) and we have considered this in forming our BCF plan. Action New / Revised Requirement Outstanding issues Funding contributions Changes to capital funding there is no allocation for social care capital in 16/17, To discuss DFGs at 31 March BCF Programme Board however, Disabled Facilities Grant (DFG) has been increased. Scheme level spending plan Out of hospital national condition as above NHS Rushcliffe CCG Funding contribution and schemes NHS Rushcliffe CCG has a mandated minimum contribution of 6,974,000 and proposes to allocate funding in the following way: National metrics Scheme Allocation 7 day services 212,730 Delayed Transfer of Care 1,401,139 Non-Elective Care 2,183,773 Protecting and supporting Social Care 3,048,704 Enabling services 127,654 The national performance metrics have remained consistent from 2015/16 plans: Metric Total non-elective admissions in to hospital (general & acute), all-age, per 100,000 population Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services Delayed transfers of care (delayed days) from hospital per 100,000 population (average per month) Question 32 from the GP Patient Survey: In the last 6 months, have you had enough support from local services or organisations to help manage long-term health condition(s) Permanent admissions of older people (aged 65 and over) to residential and nursing care homes directly from a hospital setting per 100 admissions of older people (aged 65 and over) to residential and nursing care homes New / Revised Requirement Definition change from 2014/15 to use SUS data instead of MAR data as in operational plans. Requirement for Nottinghamshire resident population remains. using BCF ready reckoner. using BCF ready reckoner. Requirement for Nottinghamshire resident population remains. BCF FPP subgroup have considered the options available for this metric and have determined that this is the most appropriate metric from the options currently available. using BCF ready reckoner and agreed in October Pooled Fund Agreement It is nationally mandated that investment in the Better Care Fund (BCF) is operated under a pooled budget agreement under section 75 of the National Health Service Act (2006). This is the legislation that allows local authorities and NHS bodies to operate pooled budgets at a local level. The draft section 75 agreement will be ed to committee members as a background paper. 3 P a g e

4 The section 75 agreement is a legally binding partnership agreement, in this instance between the commissioners of health and social care services in Nottinghamshire County. The signatories to the agreement are Nottinghamshire County Council and the six County Clinical Commissioning Groups (CCGs), namely Bassetlaw CCG, Mansfield and Ashfield CCG, Newark and Sherwood CCG, Nottingham North and East CCG, Nottingham West CCG and Rushcliffe CCG. The basis of the agreement is a national form of a model contract to administer section 75 terms, prepared by Bevan Brittan solicitors. In order to ensure local fit, both the County Council and the CCGs (acting jointly) have taken independent legal advice on the practical application in relation to the specific components of the Nottinghamshire plan. Nottinghamshire County Council has instructed its in-house legal team and the CCGs have collectively instructed Browne Jacobson. The Health and Wellbeing Board and BCF Programme Board approved changes to the BCF Pooled Fund Agreement in 2015/16 including: The non-elective admissions plan was increased and aligned to CCG operational plan targets (set out in Appendix 1 of the agreement) this reduced our pay for performance pot to A reduction in the total financial allocation for Mansfield and Ashfield CCG. Contract prices for the schemes listed in Schedule 1 for both mid Notts CCGs (Mansfield and Ashfield, and Newark and Sherwood). At the November BCF Programme Board partners were asked to consider an extension of the 2015/16 agreement as outlined in the terms and conditions. Browne Jacobson were instructed to vary the 2015/16 agreement to incorporate changes approved by the Health and Wellbeing Board in October 2015 to the 2015/16 agreement, and to extend the agreement to financial year 2016/17. The 2016/17 Pooled Fund Agreement remains consistent with the principles agreed for the 2015/16 agreement but has been updated to reflect changes in BCF policy guidance. The 2016/17 agreement has been updated to take into consideration the 2016/17 scheme spending plan and requirements for increased minimum funding allocations, and no longer refers to pay for performance as this was removed as a requirement from the BCF. As agreed in March 2015, the pooled budget will continue to be hosted by Nottinghamshire County Council, with the accountable officer and named pooled budget holder (the section 151 officer) being the Council s Service Director of Finance and Procurement who will be supported by the BCF Programme Manager. Payments Payment into and out of the pool will take place as in 2015/16: 1.1. Payments are made on a monthly basis in accordance with the payment schedule set out in Schedule 9 Payment Protocol. CCGs will contribute into the pool on the first of the month an amount equal to one twelfth of the annual sum they have agreed to contribute. On the fourth working day of the month, the County Council will pay one twelfth of the annual scheme value to CCGs, less the amount contributing to the County Council s commissioned services CCGs and the Council will pay providers directly to ensure that existing contractual payment mechanisms continue and to avoid providers receiving multiple payments from commissioners. This ensures no additional contracts are required to be set up and that no additional contract management falls to the County Council as pooled budget host For the purposes of the agreement, District and Borough Councils are a provider and payment of the Disabled Facilities Grant (DFG) allocation will be made to the pooled budget via the County Council. The DFG allocation will then be transferred to the District and Borough Councils for ongoing payment to contractors. Transfers to the District and Borough Councils will be made according to receipt of the grant e.g. if the entire grant is received on 1st April this will be transferred across to the District Councils in one lump sum, if the grant is received monthly it will be paid across to the District Councils monthly. Risk sharing 4 P a g e

5 The risk share arrangements for any overspends and management of any underspends are set out in schedule 3 of the agreement. The partners have agreed that risk sharing will initially remain at the organisation or unit of planning level in line with current practice. This means that any over/under spend will be managed by CCGs in the following units of planning: 1.4. North Notts: Bassetlaw CCG; 1.5. Mid Notts: Mansfield and Ashfield CCG and Newark and Sherwood CCG; 1.6. South Notts: Nottingham North and East CCG, Nottingham West CCG, Rushcliffe CCG. It will be for the units of planning to determine apportionment of over/under spend. Nottinghamshire County Council will manage its own over/under spend. If the overspend cannot be contained within the respective organisation or unit of planning then it will be escalated to the Programme Board for a decision. Governance and reporting CCGs and Nottinghamshire County Council are the accountable organisations with statutory responsibility for investment into the pooled budget and each has to satisfy its own statutory requirements for investment into BCF schemes. This is supported by a countywide governance structure for monitoring progress of the BCF plans including the pooled budget. The BCG Finance, Planning and Performance subgroup will continue to be responsible for providing a monthly report on the pooled budget income and expenditure. This will be reported to the BCF Programme Board monthly and include details of performance against the outcome metrics, progress with scheme delivery and outstanding risks as recorded in the programme risk register. The subgroup will undertake a quarterly reconciliation of actual income and expenditure against plan which will take into account any delays to scheme implementation and consequent payments to providers. Quarterly reconciliation reports will be presented to the Local Authority Finance and Property Committee as agreed in March There will be a quarterly report to the Health and Wellbeing Board in line with NHS England requirements. This will be accompanied by an exception report on scheme delivery, programme risks and delivery of the outcome metrics. Any changes to planned schemes financial values will be determined by the responsible statutory commissioner in the first instance, and will then be discussed through the programme governance structure with the Programme Board recommending changes in values to the Health and Wellbeing Board with the associated consideration of impact on overall programme delivery. All organisations have agreed to share relevant information with each other s auditors to ensure transparent reporting of the BCF pooled fund. Additional external audit costs may be incurred by the County Council as the pooled budget host. If this is the case, a proposal to share costs across the partner signatories will be made to the Programme Board. 5 P a g e