Guidance

Addendum to the 2022 to 2023 Better Care Fund policy framework and planning requirements

Updated 16 March 2023

Applies to England

Introduction

On 22 September 2022, the government announced its Plan for Patients. This plan committed £500 million for the rest of this financial year, to support timely and safe discharge from hospital into the community by reducing the number of people delayed in hospital awaiting social care. The focus will be on, but not limited to, a ‘home first’ approach and discharge to assess (D2A). This addendum to the 2022 to 2023 Better Care Fund (BCF) policy framework and planning requirements sets out further detail for how this £500 million fund will be distributed, as well as conditions governing its use.

This funding will be distributed to both local authorities and integrated care boards (ICBs) to pool into the local BCF. In line with usual BCF requirements, the use of both elements of this funding should be agreed between local health and social care leaders. The 2022 to 2023 BCF planning and assurance process has concluded, with formal approval letters due shortly. Therefore, a separate short template has been designed for systems to confirm their spending plans for this funding (to be made available via the Better Care Exchange). This funding should complement plans for improving discharge outcomes under national condition 4 of the main BCF plan for the area. This addendum forms additional guidance to local systems and is issued jointly by the government and NHS England (thereby acting as an addendum to both the policy framework and planning requirements).

Allocations

The funding will be distributed in 2 ways, with 40% of the money (£200 million) distributed as a section 31 grant to local authorities and the remainder (£300 million) to ICBs. We recognise that the majority of local NHS services and local authorities are currently facing significant challenges, which is why every area will receive a share of this fund. However, to maximise the impact of the fund, the allocation to ICBs will be targeted at the areas with the most significant discharge challenges.

ICB funding allocations have been determined based on a combination of:

• a fair-shares distribution based on 2022 to 2023 ICB weighted populations (25% of ICB funding)
• a discharge metric flexed to reflect the size of the ICB weighted population (75% of ICB funding)

For the 75% of ICB funding based on discharge data, the allocation shares are calculated as the ICB weighted population share weighted by the proportion of occupied beds with patients remaining in hospital who no longer meet the criteria to reside relative to the England proportion. All allocations are then rescaled by the same factor to ensure the total matches the available quantum. We have used the published management information on the number of patients remaining in hospital who no longer meet the criteria to reside and the number of adult general and acute occupied beds. We have used the July to September 2022 averages, limited to acute trusts with published discharge data (acute trusts with a type 1 A&E department and excluding specialist trusts). Where there is only data published at trust level (such as occupied beds), we have used the 1-1 published trusts to ICBs mapping for financial planning and reporting purposes, in line with the published discharge data.

Allocations for specific health and wellbeing boards (HWBs) have not been set within the funding distributed via ICBs. This funding should be pooled into local BCF agreements (governed by section 75 of the NHS Act 2006) and ICBs should agree the distribution based on agreement with LA partners, dependent on local context and challenges. Allocations to ICBs can be found at Annex D.

Local authority funding allocations have been determined using the established Adult Social Care Relative Needs Formula (ASC RNF) . Where there have been local authority boundary changes, we have used the same ASC RNF allocation shares as those in the Department for Levelling Up, Housing and Communities (DLUHC) final local government finance settlement for 2021 to 2022. This applies to the local authority geography changes in April 2019 (Dorset, and Bournemouth, Christchurch and Poole unitary authorities) and in April 2021 (North Northamptonshire and West Northamptonshire unitary authorities). Allocations to local authorities can be found at Annex C.

Funding will be allocated to ICBs and local authorities in 2 tranches. The first tranche (40% of the total allocation) will be in December and the second tranche (60% of the total allocation) in January. The second tranche is contingent on receipt of an initial completed planning template (to be submitted 4 weeks after details of the fund are published) and meeting of the funding conditions. Further details on these conditions and reporting requirements are set out below.

Funding conditions

Ministers have set specific conditions governing the use of this additional funding:

• local authorities and ICB funding allocation should be pooled into local BCF section 75 agreements with plans for spend agreed by LA and ICB chief executives and signed off by the HWB under national condition 1 of the BCF
• funding allocated to ICBs should be pooled into HWB level BCF section 75 agreements. ICBs should agree the distribution of this funding with LAs in their area and confirm the agreed distribution to the BCF team (via the planning template)
• funding should only be used on permitted activities^{[footnote 1]} that reduce flow pressure on hospitals, including in mental health inpatient settings, by enabling more people to be discharged to an appropriate setting, with adequate and timely health and social care support as required
• funding should prioritise those approaches that are most effective in freeing up the maximum number of hospital beds and reducing the bed days lost within the funding available, including from mental health inpatient settings. D2A and provision of homecare is recognised as an effective option for discharging more people in a safe and timely manner. Residential care to meet complex health and care needs may be more appropriate for people who have been waiting to be discharged for a long time
• ICBs should ensure that support from the NHS for discharges into social care is available throughout the week, including at weekends

• The Department for Health and Social Care (DHSC) and NHS England (NHSE) may follow up with local areas to understand and/or challenge the planning approach - this may happen:

  • if plans do not clearly demonstrate prioritising activity to free up the maximum number of hospital beds, and reduce the bed days lost;
  • where it is evident that spending plans are in breach of other funding conditions
  • where data shows that delayed discharges are significantly higher or increasing at a greater rate than national averages
• a progress review across all areas will take place in January. Local areas will be expected to engage fully in this process - see more details are set out in ‘Monitoring Compliance and Support for Implementation’
• a completed spending template should be submitted 4 weeks after fund details are published (by 16 December 2022), confirming planned use of the additional funding and that the use of the funding has been agreed by the ICB and local authority. Spend against the first tranche of money can commence as soon as plans are agreed locally. Allocation of the second tranche of funding will be contingent on having submitted the completed spending template and meeting of the funding conditions
• local areas should also submit fortnightly reports setting out what activities have been delivered in line with commitments in the spending plan - see more details below in the ‘Reporting’ section
• ICBs, hospital trusts and local authorities should work together to improve all existing NHSE and local authority discharge data collections including related situation reporting data and discharge data submitted as part of the commissioning data set
• as a minimum social care providers must keep the required capacity tracker data updated in line with the Adult Social Care Provider Provisions statutory guidance, however it is acknowledged that more frequent updates to bed vacancy data is essential for operational purposes. We recommend updating bed vacancy data daily, where possible, as this information can be used by local discharge and brokerage teams when planning patient discharges. Keeping this data up to date is imperative for ensuring that patients are discharged to the right place for their specific care needs. It also assists with keeping both staff and residents as safe as possible by ensuring providers can accept admission of residents whose specific care needs can be met

Reporting

The planning template (to be made available through the Better Care Exchange) should be populated to clearly set out how this funding will be used within the context of the funding conditions. The template includes an expenditure sheet like that in the main BCF planning template. The scheme types focus only on spend that is relevant to this funding and incorporate additional expenditure categories related specifically to the recruitment and retention of the social care workforce. Some expenditure types require confirmation of the number of packages of care or beneficiaries linked to the expenditure.

The template is prepopulated to show the minimum local authority allocation. The template also contains guidance for how ICBs should confirm the distribution of funding to individual HWBs in the ICB system area. The template will calculate spend to help HWBs ensure that the planned spend covers the full allocation. Local areas may use up to 2% of their total allocation (local authority and ICB) for reasonable administrative costs associated with distributing and reporting on this funding.

An initial spending plan should be submitted through the BCF programme no later than 16 December 2022. Thereafter, fortnightly activity reports should be submitted for each local authority footprint, detailing what activities have been delivered in line with commitments in the spending plan. An end of year report should also be submitted (alongside the wider BCF end of year report), detailing total spend of this fund, by 2 May 2023.

Metrics and Monitoring

The impact the additional funding is having will be tracked by the following metrics:

• the number of people discharged to their usual place of residence (existing BCF metric)
• the absolute number of people ‘not meeting criteria to reside’ (and who have not been discharged)
• the number of ‘Bed days lost’ to delayed discharge by trust (from the weekly acute sitrep)
• the proportion (%) of the bed based occupied by patients who do not meet the criteria to reside, by trust
• the number of care packages purchased for care homes, domiciliary care and intermediate care (to be collected through a new template)

In addition, the data on length of stay will be monitored regionally and nationally and continues to be available on the Better Care Exchange.

Monitoring compliance and support for implementation

NHS England and DHSC will monitor continued compliance against the funding conditions set out above, through interactions with local areas and scrutiny of the spending reports and the discharge related metrics. Where there are higher or increasing delayed discharges (beyond the national average) or where there are significant challenges, local areas will be offered a package of support to encourage improvement. In these cases, the expectation will be that ICBs (including relevant trusts) and local authorities will implement the recommendations provided by the support programme teams.

A progress review across all areas will take place in January. Where there are persistent challenges or non-compliance with funding conditions, or if funds are not being spent in accordance with the agreed plan, NHS England and DHSC, in collaboration with the National Discharge Taskforce, will follow up with local areas to challenge the planning approach and provide additional scrutiny of spending. All local partners are expected to engage fully with this process where necessary.

List of annexes

The list of annexes published alongside this document are:

• Annex A – local authority grant determination letter
• Annex B – local authority grant conditions
• Annex C – local authority allocations
• Annex D – ICB allocations

1. The NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000 set out the legal framework for pooling of funds between LAs and NHS bodies, including prescribing the NHS functions and health-related functions of LAs which the pooled funds can be used in the exercise of. ↩