Agenda item

Herefordshire's Better Care Fund (BCF) and Integration Plan 2017-2019 and extension of s.75 agreement

To agree the extension of the existing section 75 agreement to 31 March 2019 and approve the council's contribution to the Herefordshire's Better Care Fund (BCF) and Integration Plan 2017-2019.


The cabinet member health and wellbeing introduced the report and highlighted the interdependence between health and social care. He set out the requirement for councils and clinical commissioning groups (CCG) to prepare joint plans for the delivery of key community services, funded through a pooled budget known as the Better Care Fund.  The cabinet member reported that Herefordshire’s integration plan had been signed off by the health and wellbeing board and formally approved by NHS England. The CCG had therefore been given the authority to enter into a legally binding section 75 (S75) agreement with the council for the transfer of funds from the NHS budget to social care. The draft agreement was before the cabinet.


The cabinet member stated that although funding was pooled, there was no risk share as part of the agreement. The CCG and council retained responsibility for their own services and any additional demand cost pressures placed on them.


For the first time targets had been set nationally for the number of delayed discharges from hospital. The council had met its target for September, being the last month for which data was available, and initial analysis suggested performance had improved further since then. Cabinet members commended staff in achieving and exceeded these targets.


Group leaders were invited to present the views of their group.


The leader of the independent group asked what the backup plan would be if one partner in the agreement failed. The leader of the council agreed that a written answer would be provided.


The leader of the green group noted that paragraph 7 point c of the report set a measure of having an increasing proportion of people aged 65 and over who were still at home 91 days after discharge from hospital. She stated that there were pressures around this target and asked if the council was still meeting that target. The leader of the council agreed that a written answer would be provided.


The leader of the it’s our county group confirmed that questions from his group had been submitted in writing ahead of the meeting. The IOC group recognised and commended the work of the council and its partners in reaching the current point. The risks of additional costs incurred through winter pressures such as flu outbreaks were noted and the group asked for reassurance that the council would not be directly liable for additional financial contributions or that BCF grants would not be jeopardised.


The director for adults and wellbeing confirmed that the contributions by the council and the CCG to the BCF were fixed and that a number of the services included within the plan operated under fixed price contracts. Where services were linked to demand the council and the CCG each bore their own risk. There would be no expectation of additional contributions to the BCF. If there were demand led pressures on the NHS these would be for the NHS to manage.


The cabinet member for finance, housing and ICT asked what opportunities there were for either partner to withdraw from the S75 agreement during its term and whether the terms of the agreement could be changed midway through.


The director for adults and wellbeing explained that under section 75 of the NHS Act 2006, NHS bodies and councils were able to pool budgets so that by working together they could deliver better health outcomes. The BCF used that power to enable a significant transfer of funding from the NHS to the council. This was roughly £5m in the financial year 17/18. One of the conditions of the funding being transferred was that this be done through a S75 agreement. The legislation stated that it was for NHS England to decide whether to make the funding available or not and the plan had therefore been through a national assurance process. The legislation also gave NHS England the power to set the conditions of the grant.



Resolved that:


(a)  the council’s contribution to the better care fund of £20.147m revenue and £1.706m capital for 2017/18 and £20.530m revenue and £1.853m capital for 2018/19, as set out in paragraph 26 of the report below, be agreed;


(b)  the option to enact the extension of the existing section 75 agreement to 31 March 2019 is agreed; and


(c)  the director for adults and wellbeing be authorised, following consultation with the solicitor to the council and s151 officer, to take all operational decisions necessary to approve the scheme level detail within the extended s75 agreement.

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