2015 Report details for project: Better Care Fund

Project name: Better Care Fund - there is only one report for this project
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Organisation: DOH (D12) - see all reports for this organisation
Report year: 2015 (data is from Sept 2014)
Category: Transformation - see all reports for this category
Description: • Demographic change creates unprecedented challenge. In just 15 years’ time, the number of over-65s will have grown 50% and the number of over-85s will have doubled. The fact that a child born in Britain today has a one in three chance of reaching 100 years of age means this challenge will only get harder. • Ministers therefore concluded that, to ensure the sustainability of the care we provide, we have to change our focus from simply treating illnesses, to keeping people well and living independently for as many years as possible and integrate our health and social services. • To drive this they have decided to pool budgets between CCGs and Local Authorities to encourage them to work together and drive the integration agenda forward. • Local areas first submitted their BCF plans (detailing how pooled budgets would be planned to be spent in that area) in April 2014. However the quality and aspiration of these plans was not as expected and as a consequence the BCF Task Force was set up on the 7th of July 2014 to work with local areas to improve the quality of plans, assess them and provide assurance to ministers. The objective of the policy is to accelerate the local integration of health and care services to deliver better outcomes for patients and service users. The Task Force has a narrow focus and its objectives are as follows: • Oversee creation of, assurance and sign off plans across the country which utilise the opportunity of the pooled funds to best effect and support achievement of the purpose; • Support the system to prepare for delivery of plans By the end of October 2014 all 151 plans will have been assessed and assured against the agreed set of national conditions. They will be given an assessed status of either: approved; approved with support; approved with conditions; or not approved. The assessment and assurance process will seek to deliver plans that will include: • A clear analytically driven (i.e. risk stratified) understanding of where care can be improved by integration (of budgets, commissioning, care processes or services) • A clear and evidence based plan of action, developed with all local stakeholders (CCG, LA, HWBB, NHSE, acute and non-acute providers and primary care providers) • A coherent and believable delivery chain with clear local management and accountability arrangements • A credible way of tracking the impact of interventions, and taking remedial action as necessary • P4P mechanisms that are agreed and support delivery of the SR settlement and NHS settlement Given that not all plans will achieve fully approved status, it has already been proposed and approved by the Task Force Programme Board that the Task Force be extended beyond October to support areas to get their plans to a fully approved state and help areas prepare for April. The Task Force is currently scoping this Phase 2 of activity which will run from November 2014 through to March 2015. Phase 2 will include the following objectives: • To have the majority of plans fully approved and ready for implementation • To align the BCF plans with BAU NHS and Local Government planning processes • Support local areas to prepare for and focus on the delivery of BCF plans • Communicate a strong narrative to the public, and health and social care staff on the value of Integrated Care • Alignment with other health and social care integration initiatives • Prepare for and take part in longer term policy development such as the next spending review Task Force Phase 2 benefits are still being analysed however they are expected to include the raising of the profile of the integrated care agenda with the public and health and social care staff, and a level of assurance around the strength of the implementation of plans in local areas in preparation for April 1st 2015. Post March 2015 there will still be much work to be done in order to release the benefits to patient care that the Better Care Fund aims for. CCGs and Local Authorities are free to use their share of the funding to promote integration as they see fit. However, they should meet some national conditions to ensure a minimum level of consistency throughout England. Conditions include ensuring 7 day health and social care services, preventing unnecessary hospital admissions and reducing delayed transfers of care, to making sure one lead professional is accountable for all of a person’s care throughout the new integrated system. It is currently unclear whether post March 2015 work will be overseen and monitored via existing structures within Local Government and the NHS or if there will be some requirement for further work or support from a central team such as the Task Force. The current Task Force currently has no scope or remit post March 2015.
DCA (RAG): Amber/Red
DCA text: The MPA RAG rating was Amber/Red at Q2 2014. There were major risks and issues that are apparent in a number of areas around plan submittal and quality and aspirations around plans: 1) The timescales set for local areas to submit plans which are of the required quality and aspiration are challenging which may lead to the number of plans that are 'not approved' being larger than what was hoped for by many stakeholders 2) The timescales during which the Task Force could provide support to areas was short therefore there was a risk that plans may not substantially change in quality from the previous submission 3) The local settings in which plans were being developed were complex with many and varied stakeholders (social care, local Government, NHS, HWBs, CCGs) and development of a robust and quality plan requires agreement across sectors All of these issues and risks were actively managed and actions included: • Plan improvement support over the summer for local areas included webinars, regional clinics, practical guides and intensive hands on support. • A Governance Structure to feed key decisions was set up and included regular meetings with the SoS Health, a X Ministerial Board and BCF Programme Board. • Three Checkpoints gave some visibility of area readiness to submit plans and the results were fed into support arrangements, with any changes being made that were appropriate • Five Fast Track areas submitted plans at the end of August and were ‘approved with support’ via the National Consistent Assurance Review process (NCAR). • All remaining BCF plans were submitted and went through the NCAR process, receiving approval statuses. • The Taskforce was extended to continue into Phase 2, running from the end of October to the end of March. The objectives for this phase were to plan and develop the detail for support offerings and assurance for local areas post NCAR results. Progress to date: Since Q2, all plans not fully approved in October have been resubmitted following the delivery of support to areas not fully approved: areas in the 'approved' and 'approved with support' categories were mainstreamed into NHS England and LG mechanisms to enable them to progress with implementation. Those areas in the 'approved with conditions’ and ‘not approved’ categories worked with a team of Better Care Advisors and experts from a PA-led consortium to support them to strengthen their plans, break through issues and resubmit plans. As of 26th January 2015, of 150 plans: 120 have been fully ‘Approved’; 4 are categorised as ‘Approved with Support’; the remaining 26 plans have been resubmitted and are currently undergoing the Nationally Consistent Assurance Process with a formal outcome on the 6th February. An escalation process is in place for areas who fail to reach either ‘Approved’ or ‘Approved with Support’ categories in this final wave of resubmissions. A KMPG-led consortia of experts has been engaged to lead implementation support nationally, with support being led regionally by NHS England regional leads with local government colleagues. The current Taskforce currently has no scope or remit post March 2015 but work is underway to develop plans for a core team, resourced jointly by NHS England, DCLG, DH and LGA, to continue supporting the success of the Better Care Fund centrally.
Start date: 2014-07-07
End date: 2015-03-31
Schedule text: The planned schedule from Q2 has been kept, with additional milestones added as Phase 2 has progressed. Key milestones achieved have been putting in place remedial arrangements and support for areas unable to sign off a plan of sufficient quality/ambition, reviews undertaken for area plans in October and the majority of plans reaching approved status by January 2015. Phase 2 of the Taskforce was an extension not initially planned for when the TaskForce was first set up. The extension developed in order to allow the TaskForce to fulfil its objectives and coordinate continuing support required by a number of areas facing challenges in submitting plans of the required detail and quality, as well as to ensure that the appropriate implementation support and planning was in place in the run up to April 2015.
Baseline: £5.38m
Forecast: £5.38m
Variance: 0.00%
Variance text: Budget variance less than 5%
Whole Life Cost: £5.38m
WLCost text: The BCF Taskforce Phase 1 ran from the 7th of July 2014 to the 31st of October 2014. It was forecast a cost of work done in Phase 1 of £3.5m, which included: costs of employing a Programme Director and support; professional PMO support; admin support; delivery of the Nationally Consistent Assurance Process and validation of this process; assessment of Fast Track plans; support to 6 Fast Track plans; meta-analysis of data; plan improvement support; local government networks. The actual cost of Phase 1 was £3.86m. The scope for Phase 2, running from 31st October to 31st March, was still being developed in detail in Q2 and dependent on 1) An understanding of the number of areas whose plans are approved with conditions, approved with support or not approved in September as this will impact the shape and size of any Task Force provided support in Phase 2 2) The feedback from Programme Board and Stakeholders over the coming weeks as the scope for Phase 2 is socialised with them. The costs included all those for Phase 1 less the local government networks and also including Better Care Advisors and events. The Taskforce was forecast a final cost of work done for Phase 1 and Phase 2 of £5.38m at the end of March 2015 in Q2. The current forecast in Q4 is £6.13m: an additional budget amount of £778,197.00 was repurposed from identified SCLGCP savings in October and the updated budget situation was noted by the BCF Programme Board on the 14th October 2014. It was agreed at the Programme Board on the 14th of October that Plan Implementation Support would be procured to support areas with the implementation of their plans, this support is being funded (approx £1.2m) and procured via NHS England and is not included in the Taskforce's full life costs.
Notes1: DOH NON CAPITAL
Notes2:
Sourcefile: IPA_2015.csv

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Acknowledgement: GMPP data has been re-used under the Open Government Licence.