Policy paper

Better Care Fund: policy statement 2020 to 2021

Published 3 December 2020

This was published under the 2019 to 2022 Johnson Conservative government

Applies to England

Introduction

1. The government’s mandate to the NHS, published in March 2020, set a deliverable for the NHS to ‘help ensure delivery of its wider priorities, which include manifesto commitments to further improve the experience of NHS patients, working with local government to support integration and the sustainability of social care through the Better Care Fund (BCF)’.

2. Earlier in the year, Health and Wellbeing Boards (HWBs) were advised that BCF policy and planning requirements would not be published during the initial response to the COVID-19 pandemic and that they should prioritise continuity of provision, social care capacity and system resilience and spend from ringfenced BCF pots based on local agreement in 2020 to 2021, pending further guidance. Given the ongoing pressures on systems, Departments and NHS England and NHS Improvement have agreed that formal BCF plans will not have to be submitted to NHS England and NHS Improvement for approval in 2020 to 2021.

3. HWB areas must, however, ensure that use of the mandatory funding contributions (Clinical Commissioning Group (CCG) minimum contribution, improved Better Care Fund (iBCF) grant and the Disabled Facilities Grant) has been agreed in writing, and that the national conditions are met.

4. HWBs will be required to provide an end of year reconciliation to Departments and NHS England/ Improvement, confirming that the national conditions have been met, total spend from the mandatory funding sources and a breakdown of agreed spending on social care from the CCG minimum contribution.

Table 1: minimum contributions to the BCF, 2020 to 2021

BCF funding contribution	2020-21 (£m)
Minimum NHS (Clinical Commissioning Groups) contribution	4,048
improved Better Care Fund	2,077
Disabled Facilities Grant	573*
Total	6,698

*£505 million paid to LAs in May 2020 plus an additional £68 million paid in December 2020

5. Clinical Commissioning Group (CCG) minimum contributions to the BCF were published with the original NHS Operational Planning and Contracting guidance in February 2020. Grant Determinations for the improved Better Care Fund (iBCF) and Disabled Facilities Grant (DFG) have been issued to local authorities and require that use of the grants is agreed in local BCF plans.

Better Care Fund 2020 to 2021

6. The national conditions for the BCF in 2020-21 are that:

• Plans covering all mandatory funding contributions have been agreed by HWB areas and minimum contributions are pooled in a section 75 agreement (an agreement made under section 75 of the NHS Act 2006).
• The contribution to social care from the CCG via the BCF is agreed and meets or exceeds the minimum expectation (see paragraph 9).
• Spend on CCG commissioned out of hospital services meets or exceeds the minimum ringfence (see paragraph 10).
• CCGs and local authorities confirm compliance with the above conditions to their Health and Wellbeing Boards.

7. As in previous years, areas should ensure that local housing authorities (district councils in two tier areas) have been engaged in the use of the DFG, and that, where appropriate, grant money has been passed to district councils.

8. CCGs and local authorities should also ensure that local providers of NHS and social care services have been involved in planning the use of BCF funding for 2020 to 2021. In particular, activity to support discharge funded by the BCF should be agreed as part of the whole system approach to implementing the Hospital Discharge Service Policy and should support an agreed approach for managing demand and capacity in health and social care.

Social care maintenance

9. The 2019 spending round confirmed that contributions to social care from CCGs via the BCF for 2020 to 2021 should increase by 5.3% to £4.048 billion in line with NHS revenue spend. The minimum expectation for each HWB area is derived by applying the percentage increase in the national CCG contribution to the BCF from 2019-20 to 2020-21 to the 2019-20 minimum social care maintenance figure for CCGs. These minimum expectations have been placed on the Better Care Exchange. HWB areas should review the spending on social care funded by the CCG contribution to the BCF to ensure that the minimum expectations are met, in line with the national conditions.

NHS commissioned out of hospital services

10. HWB areas should ensure that spending on CCG commissioned out of hospital services (which can include social care) meets or exceeds the minimum ringfence set out in the BCF allocations spreadsheet published on 4 February.

Better Care Fund Plans

11. Spending plans will not be assured regionally or formally approved. Local authorities and CCGs should ensure that robust local governance is in place to oversee BCF funds. This includes placing the funding into a pooled fund governed by an agreement under section 75 of the NHS Act 2006 with an appropriate governance structure, that reports in to the HWB.

12. A short template will be made available on the Better Care Exchange for systems to use locally to calculate spend and compliance with the conditions on maintenance of social care and CCG commissioned out of hospital expenditure.

13. Better Care Managers (BCMs) will be able to advise areas on these conditions. If an HWB is not able to confirm agreement and compliance with any of the items above, the area should notify their BCM. Support and advice will be available, and the national Better Care Fund Team will be able to commission external support to agree use of the funding if necessary.

14. During 2020 to 2021, additional funding has been made available to support the Hospital Discharge Service Policy, providing fully funded care for people discharged from hospital with additional care and support needs from 19 March 2020 to 31 August 2020, and up to 6 weeks reablement or rehabilitation from 1 September 2020 to 31 March 2021. HWB areas were asked to place the additional funding into a pooled fund governed by a section 75 agreement, and a template section 75 variation document was published. Where an area has added this additional funding into its BCF pooled fund, the additional funding is not covered by BCF national conditions. Nor does it count towards the minimum contribution to social care (see paragraph 9) or the minimum ringfence for out of hospital care (see paragraph 10). Areas can record activity funded through this additional funding source as an additional voluntary contribution.

Monitoring and reporting

15. Areas should keep records of spending against schemes funded through the BCF. Areas will be asked to report actual income and expenditure as normal year end reporting as well as details of spending on maintaining social care spending from the CCG minimum contribution and out of hospital services, in line with the national conditions.

16. Areas must continue to actively participate in local BCF governance mechanisms in place during the year (including the governance arrangements set out in the relevant section 75 agreement(s)) to ensure that BCF funding is used to best effect and accounted for appropriately.

17. HWB areas are not expected to submit local trajectories for the BCF national metrics for 2020 to 2021 but should continue to work as a system to make progress against them. National reporting of Delayed Transfers of Care was suspended from 19 March 2020. Local areas are reporting on a new set of metrics under the Hospital Discharge Service Policy.

Better Care Fund in 2021 to 2022

18. The Spending Review 2020 confirmed that the iBCF grant will continue in 2021 to 2022 and be maintained at its current level (£2.077 billion). The Disabled Facilities Grant will also continue and will be worth £573 million in 2021 to 2022.

19. The CCG contribution will again increase by 5.3% in line with the NHS Long Term Plan settlement.

20. The Policy Framework and Planning Requirements will be published in early 2021.