Disabled facilities grant
The disabled facilities grant (DFG) is a capital grant paid from the Ministry of Housing, Communities and Local Government (MHCLG) to local authorities in England to adapt older and disabled people’s homes to help them to live independently and safely. Adaptations can include ramps, stair lifts and suitable heating systems. The DFG, which has run for more than 30 years, became part of the Better Care Fund (BCF) in April 2015.
The DFG aims to support disabled and older people to be independent, enabling carers to continue their role safely, preventing accidents and helping people to return from hospital. It therefore crosses the boundaries between housing, health and social care and reflects the increasing national focus on the integration of housing with health and social care services.
Since the DFG became part of the BCF there has been a significant increase in central government resources. In 2014/15 central government provided £220 million through the grant, but by 2017/18 this had almost doubled to £431 million in total and for 2020/21 is £573 million. Responsibility for funding the DFG is now held by the Department of Health and Social Care. The MHCLG continues to lead on policy and the distribution of funding.
Improved Better Care Fund (iBCF)
The improved Better Care Fund (iBCF) grant was announced in the 2015 Spending Review and was introduced from 2017/18 onwards. The grant provides local government with new funding for adult social care and must be pooled alongside the clinical commissioning group and DFG funding in the BCF. The original funding was increased by £2 billion in total from 2017/18 to 2019/20 in the 2017 March Budget, rising to an annual allocation of £1.837 billion by 2019/20.
In 2020/21, the £240 million winter pressures grant was combined with the iBCF. The value of the iBCF in 2020/21 was £2.077 billion.
The fund is paid directly to local government and must be used to support social care activity.
Purpose of the iBCF
The iBCF is passed to local authorities with social care responsibilities as a Section 31 grant, with conditions. The grant determination in 2020/21 requires the money to be used only for the purposes of:
- meeting adult social care needs
- reducing pressures on the NHS, including seasonal winter pressures
- supporting more people to be discharged from hospital when they are ready
- ensuring that the social care provider market is supported.
Conditions were placed that a recipient local authority must:
- pool the grant funding into the local BCF, unless the authority has written ministerial exemption
- work with the relevant CCG and providers to meet National condition 4 (managing transfers of care) in the Integration and BCF policy framework and planning requirements 2017/19
- provide quarterly reports as required by the Secretary of State.
Additional Discharge Fund
The £600 million adult social care discharge fund was announced in September 2022, with £300 million channelled through integrated care boards and another £300 million through local authorities. All the funds are to be pooled in the better care fund and delivered in two tranches in December and January.
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. Local areas are required to set out how they intend to use the additional discharge funding and submit fortnightly reports throughout the year, setting out – among other information – the additional services commissioned with the funding and the numbers of patients receiving short-term support following discharge.
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.