Better Care Fund Planning

The £3.8bn Better Care Fund (formerly the Integration Transformation Fund) was announced by the Government in the June 2013 spending round, to ensure a transformation in integrated health and social care. The Better Care Fund (BCF) is one of the most ambitious ever programmes across the NHS and Local Government. It creates a local single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their well-being as the focus of health and care services.

The BCF is a critical part of the NHS 2 year operational plans and the 5 year strategic plans as well as local government planning.

Better Care Fund webinars on updated guidance and templates (August 2014)

There will be a series of webinars in early August to follow on from the updated guidance which was issued in July. Please visit the webinars page for further information.

Updated Better Care Fund guidance and templates (July 2014)

Following submission of BCF Plans in April, updated guidance has now been issued. This replaces and supersedes the guidance that was issued in December 2013.

Please see the cover letter from Andrew Ridley, Better Care Fund Programme Director, setting out the main changes to the Better Care Fund Programme.

Updated Better Care Fund guidance (July 2014)

Please note that the Technical Guidance was revised on 18 August to update on the average cost for non-elective admissions, and to provide further worked examples on payment for performance in annex 1  – revised version below.

Updated Better Care Fund templates (18 August 2014)

*UPDATE 18 AUGUST* Please note that a number of technical amendments have been made to the Part 2 plan template. The new template is available below, and any old versions should be discarded. A macro is also available for download for areas who have already started their Part 2 plans to avoid having to start again. A summary of what has changed is contained within the spreadsheet.

Better Care Fund allocations

Better Care Fund statistical significance calculator

The statistical significance tool can be used by areas to aid in developing robust levels of ambition around their supporting BCF metrics. To note, for the ‘pay for performance’ metric (non-elective admissions) although there is an expectation that areas should meet a specific % improvement,  areas are able to set their own levels of ambition and take account of local considerations. Issues of statistical significance can therefore still be an important consideration for areas.

Better Care Fund resubmission process

Both parts of the plans are to be submitted by 12 noon on 19th September 2014. Please send as attachments to: bettercarefund@dh.gsi.gov.uk as well as to:

  • the relevant NHS England Area Team; and
  • the relevant local government representative.

For information, the mapping of CCGs to HWBs, and HWBs to Area Team and Local Government Region contacts can be found here.

If there are any queries about the resubmission process, please contact bettercarefund@dh.gsi.gov.uk.

The methodology for the National Consistent Assurance Review is now available, so that areas are able to understand how their BCF plans will be assessed after they have been submitted on or before 19 September” (August 20th 2014)

BCF support

Making it Better – A guide to resources for improving Better Care Fund plans

To help local areas achieve the excellent plans to which they aspire, we have developed a robust programme of support. This slide pack, entitled “Making it Better – A guide to resources for improving Better Care Fund plans” provides more detail on what support will be available and how to go about accessing it.  It also brings together a selection of resources that you can access immediately that will help you in developing a robust plan and roadmap for delivering integrated care. Over the coming weeks, as and when new resources are developed, we will add those into the “Making it Better” guide and highlight new content in theis weekly BCF bulletin email from Andrew Ridley.

Contact details for NHS regional and local area teams, and LG regional leads

“The Making it Better guide” provides details on how to access targeted and bespoke support. It will be necessary to go via your relevant NHS regional team, cc’ing in your Local Area Team and local government regional lead. The email addresses you need can be found in this document.

BCF webinars

Please see here for details about forthcoming BCF webinars, as well as archived webinars for reference.

If you have any queries around the Better Care Fund Plan, please post a question in the comments section below. However, before posting a question below, please check the BCF Frequently Asked Questions document (updated 20 august 2014) which also includes questions that have been raised in the webinars held to date.


Please note that the information below is now out of date. However, as some of the material may still be useful, it is displayed below for reference.

Previous joint letters

NHS England, alongside the Local Government Association (LGA), published a series of joint letters to the NHS and local government, with details of the BCF and its requirements.

Previous guidance

Leave a Reply

Your email address will not be published.

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

98 comments

  1. We already have built into our plans a reduction of 3.5% in emergency admissions as part of our QIPP to deliver our financial plan. I note in the Q&A that we are not expected to do another 3.5% in addition to our QIPP plans for 15/16 which then means we will not have any funding released from the Acutes to put into the BCF as this is already in our financial plan. We do not have any excess funding as we already have a planned deficit so we were going to only move existing scheme funding with costs into the BCF is this still appropriate?

  2. Phil Stephens says:

    In the recently published “BCF National Assurance Methodology” slide pack it suggests that BCF Plans will be either “Approved”, “Approved with Support”, Approved with Conditions” or “Not Approved”.
    If a plan is approved with conditions or not approved, the slide deck indicates that sic “conditions will be set……..before an area is given responsibility for all or part of the BCF budget”
    Does this mean that money will be withheld from the previously published CCG allocations for 2015/16 until conditions are met?

  3. debbie burnicle says:

    the latest weekly BCF update from Andrew mentioned supplementary guidance re emergency admission target to be available yesterday on bcf page – I cant seen this on the bcf page?
    Can u advise when this will be available or where this is? thanks

  4. Jo Cowley says:

    Is it possible to set more than one local metric? We have several CCGs in our HWB area and they would like to set different local metrics to reflect their local priorities.

  5. Keith Cheesman says:

    Hi, I think becuase the guidance is seemingly written with Unitary Authorities with a singular relationship with a CCG in mind, I’m struggling with a number of aspects around the performance process in our more complex arrangements:

    1) we are now supplied with a list of 15 CCGs with residents in my county – only 5 of which are represented at out HWB. How am I required to factor these additional 10 CCGs performance targets and achievements into our plan?

    2) with the 5 CCGs we do have, does each CCG have to set the same target, or are they able to set their own so long as the overall minimum of 3.5% target is met or exceeded?

    3) in the event of one CCG missing the target, is performance money retained by all the CCGs (ie in the event that the minumum overall threshold is not met)?

    4) I assume the 3.5% minimum relates to whole year, so levels at the begining of the year (ie Winter, and only a few months away) are able to be set realistically low to allow changes to be implemented across the system to reduce the volumes, again, so long as the whole year meets the target set?

    5) The previous BCF rounds were specifically desribed as focussed towards ‘Adult / Older People’; this new indicator appears to be an ‘all age’ one – is this deliberate and what should we specifically be considering with regard to integration of health & social care?

    Thanks.

    • NHS England says:

      Dear Keith,
      Please find below our answers to your questions:

      1) Generally we would expect HWBs to have some relationship with CCGs where there is a cross over in activity. However, it is likely that the 5 CCGs which are represented will constitute the majority of the activity for the HWB and so it should be possible to set plans on the basis of these CCGs.
      2) From the point of view of the BCF the 3.5% reduction need only apply to the overall HWB plan.
      3) The target for reducing non-elective (general and acute) admissions will be set on a HWB basis, and so if the HWB as a whole misses its target reduction all of the CCGs involved would initially be put in the PfP regime. We would expect your local agreement to set out how you would manage the PfP money in the case of different performance levels between CCGs. For example, you could agree locally that whole HWB will support the CCG who has not achieved the target; or you could set out in the agreement that each CCG is individually responsible for meeting the costs of overperformance, or that it is between each CCG and the LA. The most important thing is that it is agreed by all before the start of the year!
      4) Yes, this is correct
      5) Although the older population is particularly relevant for the BCF it will also be relevant for younger people

      Kind regards,
      NHS England

  6. Helen Stapleton says:

    Hi,

    In terms of the emergency admissions indicator, the technical guidance refers to baselines being set based on CCG activity and this being the total emergency admissions, does this mean that in terms of this metric NHS England commissioned activity is not included?

    Thank you

    • NHS England says:

      Dear Helen,

      This is correct – NHS England commissioned activity is separate in the UNIFY published CCG figures and is not included in the mapped HWB figures.

      Kind regards,

      NHS England

  7. Helen Stapleton says:

    For the last BCF submission CCGs had access to benchmarking info e.g. all local CCG baselines and this helped with setting aspirations. Is this available to help with the September submission?
    Thank you

    • NHS England says:

      Dear Helen,

      The new template is pre-populated with the HWB (and CCG) baseline data. The ‘Metric Trends’ tab also provides historic data for the 4 national metrics as well as projected activity to aid with setting aspirations.

      Kind regards,

      NHS England

  8. Hester Wain says:

    Annex 2 – Which acute providers should be approached and who should do this? I am coordinating the BCF from 6 CCGs, who have cross-boundary providers. I assume that it is reaosnable to contact all acute providers (even those out of area) and that it would be prudent to have a single request to each provider to complete the template from their host CCG.

    • NHS England says:

      Dear Hester,

      It is for each CCG, or group of CCGs, to determine which providers have a material interest in their plan. This may well include cross-boundary providers. Each acute provider that delivers a material volume of activity for the CCG should be asked to complete a template.

      Kind regards,
      NHS England

  9. Phil Stephens says:

    In answer to the question posted by Sue Morgan, NHSE say that “the 3.5% guideline minimum reduction is not a specific BCF attributable reduction in emergency admissions on top of planned reductions as per CCG Operational Plans”
    If an area’s CCG plans do not show any reduction in emergency admissions and if the same area does not have any specific BCF schemes that reduce emergency admissions then they are likely to submit a return with zero % reduction in emergency admissions. Therefore, according to the guidance, 100% of the BCF fund subject to the Pay for Performance element will be used on NHS commissioned services by CCGs in that area.
    If that same area has a good BCF plan in every other respect, will the plan be approved or will conditions be put on that area because it does not have an aspiration in its plans to reduce emergency admissions?

    • NHS England says:

      Dear Phil,

      We will be issuing guidance shortly around the 3.5% guideline target reduction in emergency admissions – in particular what would constitute credible grounds for planning below the guideline 3.5%.

      Kind regards,
      NHS England

  10. Andy Rothery says:

    Hi,

    Can you confirm whether the planned activity baseline data will be superseded by the 2014-15 actual data for emergency admissions?

    If 2014/15 actual results vary from the current planned reductions there could be a significant change to the performance pot allocation in 2015/16 or a rebase of the 2015/16 planned reductions required to achieve the required level of reductions.

    Regards
    Andy

    • NHS England says:

      Dear Andy,

      The planned activity baseline data will be superseded by the 2014-15 actual data for emergency admissions once available. The % change that areas plan for in the BCF template will then be applied to the actual baseline figures to give revised plan figures. Details of this will be available in amended guidance to be published shortly.

      Kind regards,
      NHS England

  11. Sue Morgan says:

    There seem to be missing drop down boxes on the Part 2 template.

    Is the minimum 3.5% reduction in emergency admissions a specific BCF attributable reduction on top of the planned reductions as per CCG Operational Plans?

    • NHS England says:

      Dear Sue,
      The 3.5% guideline minimum reduction is not a specific BCF attributable reduction in emergency admissions on top of planned reductions as per CCG Operational Plans – it is a guideline reduction in total emergency admissions (non-elective admissions, general and acute) and therefore CCG plans should reflect this revised ambition when the next planning round commences for 15/16.
      Kind regards,
      NHS England

  12. Josh Potter says:

    Hello
    When will further guidance ahead of the 1st August submission be released?
    Josh

    • NHS England says:

      Dear Josh,
      You may be aware that the Government announced a policy development regarding the Better Care Fund on 5 July. Work is now taking place to ensure that the implications of this are taken into account in the planning guidance and templates. These will be issued in due course, together with details of the planning timetable.
      Kind regards,
      NHS England

  13. Rob Rainford says:

    In reply to my earlier message regarding updated avoidable admissions data, you stated “we intend to publish avoidable emergency admissions data later in the year to allow areas to monitor their progress against their targets”.

    However, the data linked above still has no updates, with September 2013 the latest monthly data available. Is it possible to set up and publish monthly refreshes, even with a time-lag, as per Delayed Transfer Days indicator?

    In lieu of such a solution, can you be more specific about the next bulk refresh date?

    Thank you

    Rob

  14. Lynn Wyeth says:

    Hello all

    Have tried to look through all the info online and cannot see anything about Information Sharing Agreements for BCF, sorry if I’ve missed it?

    Has an Information Sharing Agreement / Data Exchange Agreement template been produced as yet that we can all use to get the Local Authority, CCG and NHS Trust to sign? If not, will one be forthcoming centrally?

    Also, the webinar about data sharing… the link doesn’t seem to work for me, is there a problem with it please?

    Many thanks in advance
    Lynn

  15. Amanda Lloyd says:

    I understand Jeremy Hunt is proposing that Local authorities and BCF partners develop risk share agreements. Are there any examples of this which we could look at to help develop one locally?

    • Keith Cheesman says:

      Hi Amanda,
      I’ve asked this question before and failed to find any really good examples, or very much by way of intentions to produce anything.

      I’d be very grateful if you are able to share anything you find this time around.

      regards
      Keith

  16. Ann Ogilvie says:

    Can you please post the September and January 15 dates for when updated submissions are required on the website to aid forward planning.

    Many thanks.

    Ann Ogilvie

    • NHS England says:

      Dear Ann,

      There are currently no plans for the resubmission of Better Care Fund plans beyond those which were completed in April. If any formal requirement for re-submission arises this will be communicated at the earliest opportunity

      Kind regards,

      NHS England

      • In NHS England’s letter to CCG chiefs and Regional Directors dated 4 June 2014, it was stated that:

        ‘further time should be taken for CCGs and Councils, working with Health and Wellbeing Boards (HWBs), to refine their [BCF] plans during June.’

        ‘…providing a more detailed breakdown of planned investments and savings, clarification on the impact of the BCF on total emergency admissions, and agreement on the consequential impact on the acute sector. It will be particularly important to demonstrate that adequate savings will be achieved to manage the risk of unplanned activity.’

        ‘Further guidance and a data collection template will be issued by the end of the week along with clarification on next steps and timetable, with the data required by 27 June.’

        I can see no reference on these pages and we dont appear to have received a letter yet in this authority, would you tell me please:
        a) When Councils and Health and Wellbeing Boards will be asked for that information?
        b) When the templates referred to will be published?

        Thanks
        Keith

        • NHS England says:

          Dear Keith,
          The more detailed guidance along with the data collection templates will be circulated later this week.
          Kind regards,
          NHS England

          • Anonymous says:

            Any news on the guidance yet??

          • Phil Stephens says:

            It is now almost a month since we were led to expect revised guidance and templates. I understand that revised submissions are expected by 1st August !!!! Please can you let us know when will we see revised guidance and templates?

            • NHS England says:

              Dear Phil,
              You may be aware that the Government announced a policy development regarding the Better Care Fund on 5 July. Work is now taking place to ensure that the implications of this are taken into account in the planning guidance and templates. These will be issued in due course, together with details of the planning timetable.
              Kind regards,
              NHS England

  17. Shaun Green says:

    Ambulatory Emergency Care services are being expanded across the trusts in our CCG for frail elderly and paeds as well as specific clinical conditions.
    Patients stay in their own clothes and sit in chairs before going home the same day with health and social care support.

    Under current HES counting arrangements these are counted as zero length of stay admissions.

    As they are clearly not an admission can we locally agree to remove these patients from BCF returns or have metrics adjusted ?

    Agreeing local unplanned OP tariffs would be another option but we would then lose some of the dat HES collects

    Thanks Shaun

  18. Rob Cooper says:

    Our local authority is drafting the specific agreement around the use of S 265 monies (including the additional S 256) with CCGs for 2014/15 including the perfomance measures. is there an expectiation that this agreement needs to be signed off by our Health and Wellbeing Board?

    • NHS England says:

      Dear Rob,

      As you know, the national total s.256 transfer for 2014/15 includes £200m for the Better Care Fund and £900m for social care with benefits to health (i.e. under the existing arrangements for the social care transfer.) We expect that your HWB’s share of the £200m for the BCF will be included in your BCF plan, along with performance measures. This plan should already have been signed off by the HWB.

      The remaining £900m will follow the existing process, in which NHS England transfers the money to the local authority once it has been locally agreed that the proposed spending plans will benefit health. cAs Health and Wellbeing Boards bring together the key organisations for health and care in the area, they are an excellent forum for discussions about the s256 transfer and we would encourage you to use them for this discussion, but there is no national expectation that this must happen for 2014/15.

      Kind regards,

      NHS England

  19. Phil Stephens says:

    Please can you clarify if tier 2 local authorities (Districts, City and Borough councils) were required to complete a separate BCF alongside their CCGs or was it just expected that they would be involved in the Tier 1 local authority BCF process.
    Thanks
    Phil

    • NHS England says:

      Dear Phil,

      Better Care Fund plans should be completed by upper tier local authorities and CCGs, and approved by their Health and Wellbeing Board.

      In areas where there are two tiers of local government, part of the Better Care Fund allocation (the Disabled Facilities Grant) will be passed on to tier two authorities in 2015/16 to provide housing adaptations. Tier two authorities should work with their partners in tier one authorities and CCGs to ensure that the provision of adaptations is aligned with the wider planning of investment as part of the BCF to improve outcomes for service users.

      Kind regards,
      NHS England

  20. Clare says:

    Hi there,

    Could you tell me which confidence interval methodology has been used to generate the intervals. For example, Newcombe-Wilson. Perhaps there is a paper/ link to a source of the methodology that could be posted here?

    Kind regards
    Clare

    • NHS England says:

      Dear Clare,

      The statistical significance tool uses a log-transform methodology to construct confidence intervals around a rate ratio. This is a common approach for constructing confidence intervals around metrics that can be either rates or proportions.

      Best wishes,

      NHS England

  21. Jon says:

    Hi,

    We are working to define our targets for DTOCs & avoidable emergency admissions. Both of which have seen significant growth over recent years in our locality. I am not a statistician and we don’t have access to one to explain this, so.. I can see how the statistical significance calculator can define a significant change for something which is on a completely flat trajectory but I don’t understand how it considers the underlying trend.

    For example if over the last 12 month we have seen the number of avoidable emergency admissions go from 1000 to 2000 then surely it would be statistically significant to set a target to partly contain the current rate of growth and aim for say 2500 in 12 months time?

    If I use the statistical significance calculator the only variables it appears to consider are confidence and the future denominator, in this case I think would be the projected population in 12 months which is hardly going to change so it suggests a statistically significant target would be just under 2000, which given the current trajectory would be a miracle!

    Help!?

    • NHS England says:

      Dear Jon,

      The statistical significance tools provides an estimate of the plan that would be required to see a statistically significant improvement from one period to the next. This is one piece of information you may wish to consider in setting realistic and challenging plans, along with recent trends and any other local intelligence

      Kind regards,
      NHS England

  22. David says:

    The revised BCF template specifies the time period to be used for meaures such as delayed transfers (day) and avoidable emergency admissions. If the target period is less than the baseline, this is not an issue for the delayed transfers metric but it does make the targets for avoidable emergency admissions look very much reduced because this is not averaged by the number of months (as with delayed transfers). Is this correct?

    • NHS England says:

      Dear David,
      Following the initial submission of Health and Well-being BCF plans (14 February 2014) there were a number of common issues that arose. As a result of this we have updated the template to clarify that for emergency admissions the numerator should either be the average monthly count or the appropriate total count for the time period. This will therefore make the baseline and plan directly comparable in line with delayed discharges.
      Kind regards,
      NHS England

  23. David says:

    Hi – in the spending round for 2015/16 the government stated that they will “make £335 million available to local authorities in 2015-16 so that they can prepare for reforms to the system of social care funding, including the introduction of a cap on care costs from April 2016 and a universal offer of deferred payment agreements from April 2015.” Is the £135m set aside in the Better Care Fund meant to fund all care bill costs in 2015/16 (ie has the figure of estimated costs reduced) or is the difference to be made up from elsewhere (if so where?)
    Many thanks

  24. Rob Cooper says:

    Hello – quick technical question. The new version of Appendix 2 appears to be password protected and I need to add a couple of lines to the schemes worksheet to include more than 5 schemes. How do I do this?

    Thanks

    Rob

    • NHS England says:

      Dear Rob,
      Password protection has been applied to the new planning template in order to prevent modifications that will impede the collation of all plans nationwide. However, for the finance tables extra rows can still be inserted by right clicking on the row number to the far left of the sheet and clicking ‘insert’. We have now also made a minor amendment to the workbook so that the tab containing the descriptive details of the “outcomes and metrics” can be modified as required.
      Kind regards,
      NHS England

  25. Iseult Cocking says:

    Please can you clarify what is needed in the 3rd box, Form 2, Outcomes and Metrics?
    ‘for each metric, please provide details of the assurance process underpinning the agreement of the performance plans’

    • NHS England says:

      Dear Iseult,
      As part of their role, Health and Wellbeing Boards will wish to be assured that the BCF plans are sufficiently challenging and will deliver tangible benefits for the local population, as well as addressing the conditions of the Fund. This box on the template should be used to give more information on the assurance process undertaken.
      Kind regards,
      NHS England

  26. Rob Rainford says:

    A couple more questions regarding the Avoidable Admissions indicator.

    1. Where and how will ongoing numerator data be published?

    2. Given that ONS refresh population estimates and projections on a periodic basis, will denominator data be similarly refreshed? If so, same question, where and how will ongoing denominator data be published?

    Thank you

    • NHS England says:

      Dear Rob,

      1) We intend to publish avoidable emergency admissions data later in the year to allow areas to monitor their progress against their targets – this will be in the “Better Care Fund historic, baseline and denominator data” spreadsheet on the NHS England BCF webpage (http://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/ )
      2) ONS do refresh population data and we have provided links to allow areas to update these if required, although in most cases this will only have a small impact on rates. Actual performance will be based on the most appropriate estimate/projection available at that time.
      Best wishes,
      NHS England

  27. We are seeking to add gain-share and risk-share agreements to the S.75 agreeement required for the pool, in order to ensure the whole system is able to share the benefits of any one partner’s efficiencies, cost reduction etc and perhaps to incentivise the Acute providers to buy-in more readily to their loss of income which is at the heart of the BCF.

    Does anyone have something of this kind which they are willing to share to avoid us re-inventing this particular wheel in what is likely to be months of work to define and agree?

  28. Faysal says:

    Hi, could you clarify whether the £135m towards meeting revenue costs of the Care Bill (para 14.ii in the Annex of Planning Guidance: http://www.england.nhs.uk/wp-content/uploads/2013/12/bcf-plann-guid.pdf), is coming out of the existing £1.9bn or the additional (15/16) £1.9bn of NHS funding?

    • NHS England says:

      Dear Faysal,
      The £135m to meet the revenue costs of the Care Bill is to be funded from the revenue element of the Better Care Fund. As this will be pooled funding in 2015/16, there is no immediate distinction between the two sources of funding. Arrangements for the BCF and for Care Bill pressures in 2016/17 and beyond will not be known until after the General Election in 2015.
      Kind regards,
      NHS England

  29. Charmaine Cleaver says:

    Hi. When will the questions and answers be updated with the Data Sharing and Information Governance webinar that happened on 13 February? Still need some answers to some of the questions asked. Thank you.

    C Cleaver

  30. Ben Hosksing says:

    Hi,

    In regards to the Delayed transfers of Care indicator for the better care metrics, there is a bit of confusion around what numerator should be used. The guidance itself says that we should use the total number of delayed transfers of care per month and points us in the direction of the NHS England statistics website. However the figures published here are only a snapshot and therefore do not reflect the total numbers per month.

    To add to the confusion the document published above to help with baselines shows the total number of days delayed and not the total number of patients delayed.

    Therefore my question is, should the numerator be total number patients delayed or total number of days delayed?

    Thanks

  31. Mike says:

    I just wanted to confirm with NHS England that they are aware that the 2 Local Authority Based measures (ASCOF 2A and ASCOF2B) are reliant on data collections which will cease to exist in 2013-14 (RAP and ASC-CAR returns).

    From 2014-15 onwards, a new LA Adult Social Care data collection will be in place (SALT). Although the measures will remain, the technical guidance behind the measures will change significantly and widen the cohort of people that we have to report on by eliminating the need for a person to have had a FACS assessment before we need to report on them. AS yet, no-one has clarity on how these changes will impact on our figures.

    Therefore, can NHS England confirm which basis the LA measures targets should be set on, pre-change ASC-CAR returns data, or post-change SALT returns data (as yet we have no baseline for this), and how they will be monitored, i.e. by a central team looking at published data, or by LA’s reporting their own local data to NHS England each year.

    • NHS England says:

      Dear Mike,
      The HWB targets should be based on the ASCOF measures. If changes in the data collection have a significant impact on the metric figures then this will be evaluated at that time, but targets will be assessed against the published figures.
      Best wishes,
      NHS England

  32. Phil Stephens says:

    I notice from the Better Care Fund Assurance Process Guide published on the LGA website http://www.local.gov.uk/documents/10180/12193/BCF+Guidance/4d976fb7-8a66-482b-b427-06e15b0c0d01
    that the Local Area Teams and local government peer groups that will be quality assuring each HWB BCF submission will be looking for greater levels of detail, especially around the National Conditions, than appears in the guidance recieved with the BCF templates.
    As an example in the section relating to 7 day working. The template and guidance asks for:
    “Please provide evidence of strategic commitment to providing seven-day health and social care services across the local health economy at a joint leadership level (Joint Health and Wellbeing Strategy). Please describe your agreed local plans for implementing seven day services in health and social care to support patients being discharged and prevent unnecessary admissions at weekends.”
    The Assurance guidance asks for the peer groups to look for evedience of:
    “Is there evidence of engagement with the Action Plan to deliver
    the clinical standards for seven day services (7DS) contained in
    the Service Development and Improvement Plan section of NHS
    local contracts between the CCG and providers?
     Do they indicate how they will work together to ensure that NHS
    providers meet the milestones for inclusion of the Clinical Standards for 7DS in 2014/15, 2015/16 and 2016/17? You could
    look for the following:
    - Year 1 (2014/15) – do local contracts include an Action Plan to
    deliver the clinical standards within the Service Development and
    Improvement Plan Section?
    - Year 2 (2015/16) – should those clinical standards which will have
    the greatest impact move into the national quality requirements
    section of the NHS Standard Contract?
    - Year 3 (2016/17) – are all clinical standards incorporated into the
    national quality requirements section of the NHS Standard
    Contract?
     Does the vision demonstrate a fully engaged primary care service
    in seven day provision?
     Do local plans explain how the partnership will address delivery of
    the clinical standards? Is there evidence of engagement on the
    standards which are amenable to joint action: Patient Experience;
    Multi-Disciplinary Team Review; Transfer to community / primary /
    social care; Mental health?

    Please can you clarify exactly how much detail is needed in the BCF template

    Thank you
    Phil Stephens

    • NHS England says:

      Dear Phil,
      As stated in the Better Care Fund Assurance Process Guide, the table on the national conditions is meant purely to be helpful as a guide when assessing whether national conditions have been met. It is only to act as a guide to help assess the content of the plans and prompt potential further discussions with local areas. However, it should be looked at in the round, taking into consideration local circumstances rather than being seen a definitive list.
      Kind regards,
      NHS England

      • Phil Stephens says:

        This may be hypothetical as no money will be witheld in 2015/16 but please can you clarify. If an area increases its BCF above the minimum amount, would any future payment by results be against the minimum BCF value or the enhanced BCF value. If the latter, then there is a disincentive to create a local BCF greater than the minimum amount.
        Regards
        Phil Stephens

        • NHS England says:

          Dear Phil,
          The payment for performance element in 2015/16 will apply only to the minimum BCF value. The total amount subject to payment-by-performance is set out specifically for each CCG in the latest version of the allocations spreadsheet, which is now available on this webpage. We would expect the same principle to be followed after 2015/16, but the details of any future scheme will depend on decisions taken after the next General Election and spending review.
          Kind regards,
          NHS England

  33. Graham Wilson says:

    Can you confirm that the Department of Health has scrapped plans to withhold money from areas that fail to deliver performance improvements through joint commissioning with local authorities as reported in the HSJ in 2015/16 ?

    • NHS England says:

      Dear Graham,
      The HSJ’s interview with Ministers simply confirmed the arrangements which we set out in our planning guidance in December. In 2015/16, no area will lose money as a result of the payment-by-performance system. Instead, areas which do not succeed in meeting their targets will enter a process of peer review by NHS England and local government experts to advise on recovery plans for that area. Where there are serious and sustained problems, NHS England has the power to direct CCGs or to directly commission in the same way as for medical commissioning as a whole.
      Kind regards,
      NHS England

  34. Joy Harris says:

    Has the DH decided not to withhold money from areas that fail to deliver performance improvements through joint commissioning with local authorities and replaced this approach with an offer of DH, NHSE and GLA joint “support”?

  35. Mike says:

    I am from an LA and am doing the work on permanent admissions and outcomes of short term services measure. We have reasonably accurate projections now for 2013-14. They are showing a deterioration on 2012-13 performance, so we want to use the more up to date figures to target set, as this is more reflective of where we are starting from inperformance terms.
    Is this acceptable to set baseline on 13-14 projection?

    • NHS England says:

      Dear Mike,
      You should use the 12-13 data as this is published final data. If admissions have increased in 13-14 then you can make this clear in your plan and take in to account when setting your targets.
      Kind regards,
      NHS England

  36. Phil Stephens says:

    For Delayed Transfers of Care metric, the guidance states that payment in April 2015 will be based on Apr to Dec 14 performance, i.e. 3 quarters, and October 2015 payment to be based on 2 quarters performance. Should the Outcomes and Metrics template be completed showing an annualised number for the two payment periods or be calculated for 3 quarters and 2 quarters respectively.

    • NHS England says:

      Dear Phil,
      The metric values should be the average monthly figures so that they are directly comparable. The numerator data however should preferably be the total for the period in question, not the monthly average. The same applies to avoidable emergency admissions although we’ve not specified in the template that these should be monthly average figures.
      Kind regards,
      NHS England

  37. Kim Rutter says:

    The BCF historic, baseline and denominator data only provides projection population figures for each local authority. Can the projection population figures be provided for comparator groups, i.e. North West, England etc?

  38. Mike Holden says:

    The current guidance on selecting an additional local indicator gives conflicting information on when a baseline should be available. The Better Care Fund – Technical Guidance states that ‘baseline data must be available in 2013-14′ whereas the BCF Annex of Planning Guidance says that ‘it must be possible to establish a baseline of performance in 2014/15′. Which is correct, as we plan to select the new ASCOF 2D indicator as the local metric but we will not start collecting/recording data in Adult Social Care until the new financial year as per the new SALT Return? We than propose to use the 6 months between April to September 14 as the baseline.

    • NHS England says:

      Dear Mike,
      To have sufficient baseline and performance data it will likely be necessary in most cases for baseline data to be available from 2013-14. In your example if you use Apr-Sep 2014 as the baseline then there is likely to be a limited period of data available for the April 2015 payment (given usual delays in obtaining data), and we advise that for robustness purposes areas should use, where possible, at least a 6 month period of data. However, if sufficiently robust data can be collected in the timescale of the fund for both payment periods then that is fine.

      Kind regards,
      NHS England

  39. Andy Mailer says:

    I have a few queries regarding the “avoidable emergency admissions” measure described in the Technical Guidance.
    1. The document states the April 2015 payment will be based on “Apr 2014-Sep 2015 data”. Can you confirm whether this is correct, or it should actually end in October 2014?
    2. For the second payment covering the period October 2014 to March 2015, should we be using the 2014 or 2015 ONS mid-year estimate as the denominator?
    3. Should the numerator in the second calculation be limited to those admissions made during the monitoring period only, or should we be adding in those from the first to annualise the measure?

    Thanks in advance for your help. Kind regards

    • NHS England says:

      Dear Andy,

      1) This is a mistake in the guidance – the April payment should be based on Apr-2014 to Sep 2014 (rather than Apr-2014 to Sep 2015 as stated in the guidance).
      2) For consistency across areas this should be the 2015 ONS population projection – this is shown in the baseline/planning data that we have provided on the BCF webpage.
      3) The numerator for the second payment period should only include admissions for the relevant period (Oct 2014 to Mar 2015)

      Kind regards,
      NHS England

  40. David Knighton says:

    The techical definitions guidance states that for Avoidable Emergency Admissions :

    Baseline
    Historic data will not available to HWBs so NHS England will provide baseline data in January 2014.

    Can you advise if this data is publicity available yet

    Many thanks

    • NHS England says:

      Dear David,
      This data is now available on this webpage (“Better Care Fund – historic, baseline and denominator data”).
      Kind regards,
      NHS England

  41. Sara Glover says:

    The technical guidance states that ‘You may combine a number of small schemes into a single line, provided that the total value of that line is not greater than 10% of the BCF’. Please can you clarify what this means – does it mean that no single scheme should be greater than 10%, or whether this relates to small schemes being aggregated. Our plan currently has three major schemes, including the protection of adult social services, that account for more than 10% each of the BCF financial plan.

    • NHS England says:

      Thank you for getting in touch.

      That element of the guidance is about aggregating small schemes: it is intended to avoid local areas having to fill in a lot of data about low-value schemes. There is no limit on the amount of the BCF which you can use on a single scheme; if it was agreed by the HWB, CCG and LA the whole of the BCF could be used on a single scheme.

      Kind regards,
      NHS England

  42. Tracy Bowers says:

    RE Avoidable emergency admissions. Have noted that the definition for this metric includes children. The BCF is for adult provision and therefore query if children should be inclided on the baseline and future performance measuring?

    • NHS England says:

      Dear Tracey,
      Although this includes child admissions, most admissions will be for the older population. Social care may largely focus on the older population, but there are links to all ages, and a reduction in all avoidable emergency admissions reflects improvements in the overall quality and effectiveness of the health and care system.
      Kind regards,
      NHS England

      • Tracy Bowers says:

        I believe there may be an issue with the Avoidable Emergency Admissions Historical Baseline data set. The main issue is whether the baseline information provided for the BCF is consistent with the definition in the BCF guidance document, which states:

        Composite* measure of:
        • unplanned hospitalisation for chronic ambulatory care sensitive conditions (all ages)
        • unplanned hospitalisation for asthma, diabetes and epilepsy in children
        • emergency admissions for acute conditions that should not usually require hospital admission (all ages)
        • emergency admissions for children with lower respiratory tract infection.

        The unplanned and emergency admissions acute and chronic conditions indicators state these should include “all ages”.

        However, these indicators also refer to the NHS Outcomes Framework where the same four indicators are used but the acute and chronic indicators are for adults only (i.e. Over 18’s only.)

        Reducing time spent in hospital by people with long-term conditions
        2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)
        ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 18

        3a Emergency admissions for acute conditions that should not usually require hospital admission(adults)

        I am unclear as to which set of definitions the BCF baseline data has used but my suspicion is that they have used the NHS outcomes framework definition of adults only.
        Currently our historical numbers, that include children do not match with the data in the BCF Historical data set.

        Please can you urgently confirm if the data in the BCF Historical data set – used for calculating the baselines – does or does not include children’s data?

        • NHS England says:

          Dear Tracey,

          Avoidable emergency admissions is a composite metric of 4 indicators from the NHS OF as listed in the BCF guidance, two of which are for all ages and two of which are for children. The two metrics for all ages used to be for ages 19+ but this has now been revised and is published by the HSCIC for all ages. We have therefore mirrored this in our composite – children are included for all. To note, because there is overlap between these 4 metrics then the composite metric will not match the 4 individual metrics combined, which may explain discrepancies with local data.

          Kind regards,
          NHS England

  43. Vena RAJA says:

    We have a query on delated discharges – should mental health and learning disabilities delays be included? If this is the case then our plans will be skewed
    due to the nature of the care provided under MH and fewer patients being delayed for longer!

    I am aware the Outcome sought in the techincal guidance states ” Effective joint working of hospital services (acute, mental health and non-acute) and community-based care in facilitating timely and appropriate transfer from all hospitals for all adults.”

    Could you enlighten on this ASAP? Thanks

    • NHS England says:

      Mental Health and Learning Disabilities delays are included (they are not separately reported). Regarding your comment about plans being skewed, we don’t think this is an issue – we want localities to do the most effective things locally to reduce the number of delays.
      Kind regards,
      NHS England

  44. Joanna Cooper says:

    Is there any guidance surrounding the financial benefits to be included in the BCF? Can you clarify whether funding should be input gross or net of other costs?

    • NHS England says:

      Dear Joanna,
      The requirement for financial benefits recognises that £1.9bn of the BCF funding for 2015/16 was previously part of CCG’s core allocations. To maintain service quality, the BCF’s investment needs to reduce demand for other CCG funded services, for example by improving community care so that local hospitals see fewer emergency admissions.

      There is no national standard for how you quantify these benefits. You should seek to agree the best way to do this between your HWB and local health and care providers: it’s in everyone’s interest to ensure the plan is ambitious but realistic.

      Funding should be entered into the template gross. Any relevant costs should be included in the template under ‘spending’ or the relevant financial year.

      Kind regards,
      NHS England

  45. James Mearns says:

    Good afternoon,

    I was wondering about the significance of the mapping file. Is this to help CCGs who share a Local Authority with another CCG?

    • NHS England says:

      Dear James,
      The mapping file has been shared primarily to flag those CCGs that encompass more than one HWB boundary.
      kind regards,
      NHS England

  46. The BCF Technical Guidance – financial and metrics additional guidance as above for the metric 3) Delayed transfers of care from hospital per 100,000 population references http://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/delayed-transfers-of-care-data-2013-14/ for the total monthly delayed transfers of care data however monthly data is not available on this site and is not collected, only snapshot data is available, please advise where this data can be found.

  47. MP says:

    Is the total BCF allocation for 2014/15 £1,100m, (ie additional funding for 201415 £241m) or is the additional funding £200m as shown here? The provisional Local Government spending power estimates for 201415 are basing LA allocations on £1,100m, and the CCG BCF additional allocations for 201516 also use £1,100m. Please can this be clarified.

    • NHS England says:

      The total increase in the s.256 transfer to LAs for 2014/15 is £241m. This is made up of two parts: the BCF funding and an increase in the general social care transfer. The NHS England BCF spreadsheet shows the £200m for the BCF. The existing NHS transfer to social care (as established in Spending Review 2010 and the Social Care White Paper) will rise from £859m to £900m in 2014/15. We expect the Department of Health to publish the full detail of s.256 grants to LAs for 2014/15 shortly.

      • Simon Bolitho says:

        Thanks for this clarification on the £41million. In practical terms, and mindful that all of this funding ends up in the total BCF in 2015/16, what difference does the distinction between the two parts (the £900m ‘transfer’ and the £200m ‘BCF’) mean for 2014/15 planning process and the actual transcation(s)? Will it all be part of a single s256 transfer enacted by NHS England in 2014/15? Should the two elements be linked separately to the old transfer guidance and the new BCF criteria for 2014/15, or is this irrelevant? Thanks.