Guidance

Letter to the health and social care sector from the Minister for Care

Updated 16 March 2023

Applies to England

To:

CEOs of integrated care boards

CEOs of local authorities

Directors of adult social services

CEOs of NHS acute trusts

CEOs of mental health trusts

CEOs of community trusts

Friday 18 November 2022

Dear colleagues,

Adult Social Care Discharge Fund – allocations, conditions and metrics

I am pleased to share details of the £500 million Adult Social Care Discharge Fund (‘the fund’), which was announced as part of Our plan for patients on 22 September. I know this has been much anticipated since it was announced.

Delays to discharging people from hospital when they are fit to leave continue to be a significant issue and have been highlighted in the conversations I have had in recent weeks with local authorities and social care and NHS providers. Not only does this mean fewer hospital beds available for those who need them; it also means people who would be better off recovering at home or in residential care are instead spending too long in hospital.

The Secretary of State and I thank you for your patience in waiting for further details.

We know all parts of the country are facing these challenges. The funding will be allocated to achieve the maximum reduction in delayed discharge:

• £200 million will be distributed to local authorities, based on the adult social care relative needs formula (RNF)
• £300 million will be distributed to integrated care boards (ICBs), targeted at those areas experiencing the greatest discharge delays. This is based on a combination of both:
  • 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)

We expect you to pool the funding into the Better Care Fund (BCF). The funding will be provided in 2 tranches – the first (40%) in December 2022, and the second (60%) by the end of January 2023 for areas that have provided a planned spending report and fortnightly activity data and have met the other conditions.

See Annex A for more details of the distribution approach.

What the fund will be used for

The fund can be used flexibly on the interventions that best enable the discharge of patients from hospital to the most appropriate location for their ongoing care.

Funding should prioritise those approaches that are most effective in freeing up the maximum number of hospital beds and reducing bed days lost within the funding available, including from mental health inpatient settings. Discharge to Assess (D2A) and provision of homecare is recognised as an effective option for discharging more people in a safe and timely manner.

Funding can also be used to boost general adult social care workforce capacity, through staff recruitment and retention, where that will contribute to reducing delayed discharges.

In some areas where there are particular delays to discharge of patients with long hospital stays – for instance those with particularly complex care needs – a concerted focus on supporting discharge of these patients may be important to free up hospital capacity.

Working together

It is crucial that health and care systems and providers work together across health and social care to meet the care needs of people and make best use of available resources. This includes coming together as joint teams involving NHS organisations, local authorities and social care provider representatives, for instance under the umbrella of integrated care partnerships. The department expects to work with NHSE and local authorities to support the sharing of good practice and assess the impact of the discharge fund.

Partners will need to bring together information across health and social care to monitor and improve the functioning of the discharge pathway. Along with drawing on NHS information tools, NHS bodies and local authorities should make use of the Capacity Tracker, at a minimum in line with the Adult Social Care Provider Provisions statutory guidance, to identify vacancies when a patient requires bed-based care and is unable to return to their usual place of residence. Further information on Capacity Tracker requirements and recommendations can be found in Annex B: funding conditions.

Updated Hospital Discharge and Community Support guidance will be published to explain new legal requirements around discharge and enable relevant trusts to adhere to them accurately. The guidance has been produced with NHS England to cover the duty to cooperate and the duty to involve patients and carers in discharge planning as soon as it is feasible and where appropriate. I would like to underline the importance of considering the needs of carers who may bear much of the load of caring for someone when they are discharged from hospital and who will often need to be supported by professional health and social care workers.

Upcoming publications

I want to be clear that the government recognises that discharge is just one of several pressures facing the provision of health and social care as we head into winter. For example, we also know that supporting people in their own homes is essential for the health of individuals and to avoid unnecessary admissions to hospital. We are absolutely committed to ensuring those providing and accessing care are prepared and supported to manage these demands. We will publish our full package of support for adult social care in the coming weeks.

This will include an Adult Social Care Winter Statement, which will set out what steps are being taken to support the care sector this winter, and actions for local systems to ensure they are as resilient as possible during the colder months. It will include the updated Hospital Discharge and Community Support guidance mentioned above, and further details about the National Discharge Frontrunners programme. Finally, we will publish the Workforce Recruitment and Retention Fund (WRRF) evaluation, to support the sector to prepare for this winter and support local areas in developing their plans on how to best utilise the workforce portion of this Fund.

The past few years have been some of the most challenging those working in our health and care sector have faced, and you have shown incredible commitment and resilience throughout. Thank you for all that you do.

Yours sincerely,

Helen Whately MP

Minister for Social Care

Annex A: summary of ASC Discharge Fund distribution approach

The Adult Social Care Discharge Fund will be pooled into the Better Care Fund (BCF) and divided as follows:

• £300 million will be allocated to ICBs using NHS England’s methodology based on a combination of both:
  • 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 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 (for example, 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.

• £200 million will be allocated to local authorities based on the Adult Social Care Relative Needs Formula. Where there have been local authority boundary changes, we have used the same ASC RNF allocation shares as those in the Department of 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).

See a full list of the fund’s allocations.

Annex B: funding conditions

We have set out the conditions for receipt of funds in an addendum to the BCF framework. Local authorities and ICBs will be requested to use the fund to:

• 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, to the most appropriate setting from hospital, including from mental health inpatient settings. Discharge to Assess (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 boost general adult social care workforce capacity, through staff recruitment and retention, where that will help reduce delayed discharges. This could include, but is not limited to, measures such as retention bonuses or bringing forward pay rises ahead of the new financial year.

To demonstrate this, local authorities and ICBs will be asked to work together to provide:

• a plan for spending the funding, which will be an addition to existing BCF plans, due 4 weeks after funding conditions are published. This should outline how the local authority plans to increase expenditure on discharge in comparison to their BCF plan. The department expects to receive one planned spending report per local authority
• fortnightly activity reports, setting out what activities have been delivered in line with commitments in the spending plan. Spending plans should be submitted by 16 December 2022, and the first activity report should by submitted on 30 December 2022
• a final spending report provided to the department alongside the wider end of year BCF reports by 2 May 2023

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.

As a condition of funding, all local authorities, ICBs and trusts will need to engage with a review in January 2023. 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 local areas will implement the recommendations provided by the support programme teams.

There will also be an expectation that all ICBs, trusts and local authorities fulfil any existing data collections and continue to engage with data improvement programmes already under way. This forms part of the requirements for receiving the second tranche of funding.

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.

Annex C: monitoring

Along with returns on the number of care packages purchased, the fund will be monitored using the following metrics:

• the number of care packages purchased for care homes, domiciliary care and intermediate care (to be collected through a new template)
• 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 base occupied by patients who do not meet the criteria to reside, by trust

These metrics have been selected because they are robust, timely, and minimise new burdens. Due to the nature of the fund allowing for flexibility to respond to local challenges, we have not set overall targets for each of these metrics. Rather, these metrics should guide decisions on how systems spend the funding and will provide a picture during and after winter of the impact of that spend.