Agenda item

To provide the Health and Wellbeing Board with an update regarding the Better Care Fund planning process for 2025-26.

Steve Vo introduced the report, which provided an update regarding the Better Care Fund planning process for 2025-26. In providing an update, he highlighted the following key points:

·       The national deadline for the plan to have been completed, agreed and submitted to NHSE was 31 March 2025, but, due to factors outside of the borough teams’ control, including waiting for NWL ICB to review the finance and proposals, there was no agreement to submit.

·       Brent had received an extension to submit their plan by 4 April 2025 which officers were aiming for.

·       Members attention was drawn to the challenge of the ICB asking for a 50% reduction in additional ICB funding allocated to the Brent local authority, resulting in a decrease of £864k. The Board were advised that this would have an impact on winter planning and the Brent Borough Based Partnership were undertaking detailed analysis to assess the risk posed by the reduction and identify potential measures to achieve a balanced budget.

·       As a result of the reduction in funding, decisions had been made to remove the Discharge to Assess physio service, which had been a pilot programme providing fast-tracked physio access to residents.  This service was in addition to the existing Community Physio service and work was ongoing with CLCH to support those changes and reduce any risks as a result.

·       Rachel Crossley added that she had delegated authority from the Board to sign the BCF off so that it was submitted on time. Unless there were major changes from the ICB then she would use that delegated power on 4 April 2025 to sign off and submit the plan.

The Chair thanked the presenters and invited contributions from those present. The following points were made:

·       The Board acknowledged that the 50% reduction in additional funding would have an impact and asked how officers would make decisions about what schemes to take forward. Steve Vo advised there had been 3 additional schemes under review which all had a direct impact on hospital discharges, and one would impact step-down beds. The review had found that changes to the reablement service would have the least impact as it was a pilot scheme that had no established funds. Tom Shakespeare added that the Integrated Care Partnership (ICP) was looking to undertake a comprehensive review of the rehab and reablement service over the next few months to understand productivity and where the most impact could be made with the remaining resource regarding managing hospital flow and achieving good outcomes. He advised that, whilst the ICP were having to make rapid decisions driven by the ICB’s financial position, there were plans to do an extensive piece of work to mitigate the impact of that reduction throughout the year.

·       The Board asked how they could be assured that the planning process laid out met the needs of the community. Steve Vo advised that the majority of the plan was a rollover of activity of the previous year which was assessed and evaluated every year. Any new schemes that were put in place were monitored and had outcomes measured, and where they did not achieve what was expected they would be taken off the plan. 

·       The Board asked whether the reduction in funding affected existing contracts in place. Eleanor Maxwell explained that the majority of the funding was non-recurrent, so the ICP did not enter permanent contracts as it was unclear what the funding position would be in following years. However, the health system was very conscious about relationships with providers and patients, and so sensitive conversations had taken place between CLCH and the ICP about the impact of cutting the reablement service.

·       The Board asked whether the impact of changes across NWL would help achieve waiting list targets and reduce numbers in A&E across all 8 NWL boroughs. Tom Shakespeare did not see that as the direction of travel, but saw it as an opportunity to review how the system looked at its collective resource to drive productivity. He felt that a direction of travel that took away resources from community settings and prevention would not help to achieve broader system goals, but recognised the financial challenges ICBs were under and the need to play a part in supporting that. He emphasised that, locally and nationally, the system should be moving towards prevention and community services.

·       Rachel Crossley echoed the importance of prevention and community services long term, and highlighted wider issues around NHS planning and local government planning not being aligned with long-term financial settlement. The ICP strongly advocated for the Better Care Fund and local government funding as a whole to be longer term to enable planning and recruitment of permanent staff, particularly as resource was being put into negotiations every year instead of being used to plan strategically in a preventative space. She thought there was merit in planning together at a national level and ICB level on the same timeline, early, and for a minimum 3-year period.

·       In terms of mitigations and transitions as a result of the changes, Tom Shakespeare confirmed those conversations were happening and the ICP had been clear with partners about the need to mitigate risks and work together. He added that there would be opportunities to consider where to shift investment to have the biggest impact.

In concluding the discussion and noting the update, the Board thanked officers for the honest discussion and noted the events over the previous weeks leading to the 2025-26 Better Care Fund settlement for Brent. The Board advocated for and looked forward to a shared planning approach over a longer period of time in future years.