Agenda item

Report of the Director of Integrated Adult Social Care on proposals for Hospital Discharge Funding, attached.

RESOLVED

(a) that the requested funding of £2 million in support of the hospital discharge programme, subject to Devon Integrated Care Board (ICB) agreeing the proposals regarding the recurrent use of the “supplementary improved Better Care Fund” (iBCF), be agreed;

(b) that, subject to the agreement of the use of the iBCF as set out in recommendation (a), the £2 million is funded from the Budget Management Reserve, be approved; and

(c) that further reports be provided giving regular updates in relation to the Better Care Fund and hospital discharge funding in recognition of the challenging fiscal position of the Integrated Care Partnership responsibilities.

(Councillors Biederman, Brazil and Whitton attended in accordance with Standing Order 25(2) and spoke to this item)

The Cabinet considered the Report of the Director of Integrated Adult Social Care relating to hospital discharge funding.

The Cabinet noted that the Better Care Fund, established in 2014, was the only mandatory policy to facilitate integration between health and social care and it brought together Health and Social Care funding and the Disabled Facilities Grant. Each ICB was required to hold a pooled budget with their local authority, with mandatory contributions governed by a Section 75 agreement. In 2017, there had been a major injection of funding, referred to as the Improved Better Care Fund (iBCF).

As part of the Integrated Adult Social Care (IASC) savings plans, it was proposed using the supplementary iBCF fund (£9.5 million), as allowed within the national guidance, to be allocated solely to adult social care.

In 2020/21, Government provided a national hospital discharge fund via the NHS, to help cover some of the cost of post-discharge recovery and support services / rehabilitation and reablement care following discharge from hospital, however this funding ceased in 2022/23, but with the expectation that local systems would continue to fund. 

As part of the original hospital discharge arrangements, the Council identified budget historically used to support social care cost associated with hospital discharge to pay towards the HDP, which stood at just under £1.5 million for 2023/24 and the Integrated Care Board had agreed to allocate their Continuing Healthcare (CHC) budget towards the HDP. 

The Hospital Discharge Programme had been forecast to cost between £16 million and £21 million in 2023/24, but discussions with NHS partners had led to the system agreeing to work to a £16 million budget cap in 2023/24.

Funding available currently totalled £12 million, as detailed at paragraph 2.26 of the Report, showing a potential funding gap of £4 million. 

To contain spending would require changes to processes and reduced reliance on agency support as well as development and delivery of cost reduction plans.

The Integrated Care Board had agreed to fund 50% of the £4 million shortfall, and it was proposed the Council consider funding the other £2 million from the Budget Management Reserve.

A Memorandum of Understanding setting out governance and how the fund would be managed would be drafted for the agreement of both parties.

The Chief Executive updated the Cabinet on the journey to date with this process and the importance of partnership relationships moving forward to manage budgets and demand, including the transformation of services that would be required.  

The matter having been debated and the options and/or alternatives and other relevant factors (e.g. financial, sustainability, carbon impact, risk management, equality and legal considerations and links to the Strategic Plan) set out in the Director’s Report and referred to above having been considered:

It was MOVED by Councillor McInnes, SECONDED by Councillor Hart, and

RESOLVED

(a) that the requested funding of £2 million in support of the hospital discharge programme, subject to Devon Integrated Care Board (ICB) agreeing the proposals regarding the recurrent use of the “supplementary improved Better Care Fund” (iBCF), be agreed;

(b) that, subject to the agreement of the use of the iBCF as set out in recommendation (a), the £2 million is funded from the Budget Management Reserve, be approved; and

(c) that further reports be provided giving regular updates in relation to the Better Care Fund and hospital discharge funding in recognition of the challenging fiscal position of the Integrated Care Partnership responsibilities.