Agenda item

The Cabinet considered an urgent joint report of the Chief Executive, Director of Adults and Communities, Director of Health and Care Integration regarding progress with the assurance of the Leicestershire Better Care Fund Plan 2017/18 – 2018/19 and the target for improving delayed transfers of care set by NHS England.  A copy of the report, marked ‘13’, is filed with these minutes.

 

The Director of Health and Care Integration said that in all respects NHS England had confirmed that the Leicestershire Better Care Fund Plan was acceptable, but it would not approve this without the Council’s acceptance of the target to improve delayed transfers of care (DTOC) by November 2017.  It had also threatened to withdraw funding if this was not agreed.  Like a number of others, the Director said the Authority was faced with two unsatisfactory options; to agree a target which was unreasonable and unachievable, or risk losing funding of up to £22m. 

 

The Director of Adults and Communities highlighted that responsibility for DTOC fell either to the NHS, the County Council (adult social care services), or they were a joint responsibility.  The Council was meeting its DTOC targets.  Performance across the health system to release acute care beds was also good in Leicestershire.  It did experience difficulties in respect of transfers of people with more complex mental health needs that required non-acute care in the community.  However, measures had been identified with health partners to address this.

 

The Director said that the approach of NHS England and the threat of withdrawing funding risked upsetting local partnership arrangements and could result in the Council no longer meeting its DTOC targets and more importantly, being able to meet its overall statutory responsibilities for domiciliary care.  He further highlighted that any withdrawn funds would be transferred to the NHS to procure care directly which perversely would cost the NHS more as this would be less planned and at higher rates.

 

Mr White CC said the position was very frustrating as local care, partnership working and DTOC performance by the Authority was good.  He said he also remained concerned about the possible consequences if NHS England’s target was not met.

 

Mr Blunt CC said that the NHS was in difficulty and a pragmatic approach was necessary, as despite NHS England’s method of tackling its problems, the Council was committed to working with local NHS partners to improve DTOC across the County. 

 

Mr Rhodes CC said he was concerned about how the approach of NHS England might affect the local health economy as reducing funding would risk a deterioration in the DTOC position in Leicestershire.  He said he considered the approach of NHS England to be ‘stupid’ and a result of incompetence by senior management within the organisation which could not continue.

 

 

RESOLVED:

 

(a)          Notes the current status of the assurance of the Leicestershire BCF Plan as “not approved”, the reason for this position, and the placing of Leicestershire’s BCF plan in formal escalation with NHS England as a result of this;

 

(b)          Notes the additional risks on the BCF pooled budget and the Council’s Medium Term Financial Strategy (MTFS) should any BCF funds be withheld/removed during 2017/18 or 2018/19, the impact this could have on core service provision for citizens, and the associated reputational risk for the Council and NHS partners;

 

(c)          Reluctantly accepts the DTOC target imposed by NHS England but with the following caveats:

 

(i)         The County Council continues to object to the imposition of this target by NHS England, with the significant risks that have been placed on BCF assurance, and the associated financial penalties if a compliant target is not submitted;

(ii)       In accepting this change to the submitted DTOC trajectory, the County Council expects the Health and Wellbeing Board’s BCF plan assurance rating to be reviewed and adjusted with immediate effect;

(iii)      As the County Council and partners still bear a clear risk of financial penalties during 2017/18 (if the Leicestershire, Leicester and Rutland (LLR) area does not reach the required level of improvement by November 2017) information is immediately provided to the three Councils and the three CCGs about:

 

a)        The process, scale and timing for imposing any DTOC performance penalties per the November milestone, so that partners can plan effectively for the remainder of this financial year; and

b)        Implications for local areas in relation to DTOC performance beyond November 2017 so that financial risks for 2018/19 can be assessed as soon as possible.

 

(d)          Draws the attention of the Local Government Association and the County Councils’ Network to its serious concerns about the actions and attitude of NHS England in this regard and requests them to continue to challenge Ministers so that partnership working on health and care integration is not further damaged;

(e)          Notes that a further report on this matter will be made to the Health and Wellbeing Board at its meeting on 16 November 2017.

 

REASONS FOR DECISION:

 

In July 2017, after a lengthy national delay, technical guidance was published by NHS England  for the preparation and submission of BCF Plans for the period 2017/18 – 2018/19.  This technical guidance included new requirements for improving delayed transfers of care (DTOC) with challenging expectations placed on each health and wellbeing board area in terms of the rate of improvement to be achieved during 2017/18.

The guidance also highlighted that areas with poor performance on DTOC could be subject to escalation with NHS England, external review by the Care Quality Commission and financial penalties.

 

The national conditions for the BCF Plan include a requirement that it is jointly agreed by the County Council and Clinical Commissioning Groups, including through the Health and Wellbeing Board.