Agenda item

Report of Corporate Director, People

The Board agreed to receive an urgent report which contained a summary of performance against the Better Care Fund (BCF) in 2022-23 and planning for the 2023-25 submission.  The BCF 2023-25 submission deadline of NHS England was 28 June 2023.  The Board was advised that the plans were not as advanced as would have been hoped.

The Board received a presentation on the BCF planning which set out the various components of the 2023-25 plan and were advised that it was not currently possible to provide further details of the financial plans or the metrics as confirmation of funding had not been received from North West London Integrated Care Board (NWL ICB) which was currently reviewing BCF schemes.

The Board was advised that, in terms of the financial plan, there was a delay as whilst the local authority had provided all the necessary information further detail was required from the ICB.  The ICB were reviewing the use of funding within the BCF which would have to be completed before they were able to provide the required financial information.  Although local authority officers had included indicative values for BCF in the report, it had not been possible to confirm these values with the ICB finance team.  In terms of key performance indicators, the Board was advised that there was a new indicator for the current year related to the Falls Service.

The Chair sought clarification on the risk of not meeting the NHS England submission deadline and was advised that the ICB had been in touch with NHSE to advise that it was likely that the deadline would be missed due to the work that it was undertaking on the use of BCF funding.  Harrow was in a relatively good position but likely that some schemes included in 2022/23 would be replaced in the BCF schedules for 2023/25.

In response to a question as to responsibility for sign off of the submission, the Corporate Director, People, informed the Board that as investing partners the local authority and ICB signed off but ultimately it was the Board and the ICB Chief Executive that were required to formally sign off the submission.  The Chair expressed concern that fairly late in the day the ICB were putting at risk a substantial sum of money adding that if there was to be a proper partnership between the local authority and ICB this was not the way to work.  It was unhelpful and put at risk cooperation and investment.  In response, the ICB representative indicated that she shared the Board’s concern about anything that might affect the excellent relationship between the Local Authority and the Borough Team of the ICB.  She stated that she did not believe that the proposed delay in submission represented any risk to Harrow’s funding.

Members of the Board expressed their disappointment and concern at the unacceptable position in relation to the submission and the ICB‘s view of their Finance Director’s involvement and were advised that this would be going to the ICB Executive who had agreed this approach.  The Chair stated that this reinforced the problem with the ICB composition, particularly as the Directors of Adult Social Services (DASS) had not been involved.  He requested that the Board’s disappointment and concerns be relayed to the ICB. In terms of the eight DASSs’ conversation with Finance Director, concerns were conveyed at the lateness of the request for details of outcomes as the plans had already been completed but the officers had indicated that this could be looked at next year.

The Managing Director of Harrow Borough Based Partnership expressed support for the sentiments expressed by members of the Board and undertook to represent those views and acknowledged that the methodology followed had been less than satisfactory.  There was however a shared commitment that this situation provided the opportunity to look at the process at a system level.  The Corporate Director, People advised that this approach undermined all the work done locally and that this was a financially driven review by the ICB.  The ICB Finance Director had indicated that he was going to tightly prescribe what the BCF could be used for which was a significant risk for the local authority.

In response to a question as to whether other ICBs were carrying out this type of review and the level and mix of funding at risk, the Corporate Director, People undertook to circulate the figures and advised that she was not aware of similar reviews happening elsewhere.

Other Members of the Board echoed concerns expressed in relation to discharges, care in the community and securing new investment.  The Chair reiterated that there was supposed to be a partnership and if one partner did not behave in acceptable way there was nothing to stop others behaving similarly.  The next step would be to write to NHS England and government ministers but he hoped that it would not be necessary.

RESOLVED:  That

(1)            the presentation be noted;

(2)            the Chair of the Health and Wellbeing Board, following consultation with the Director of Harrow Borough Based Partnership and Corporate Director People, be authorised to approve the final submission for BCF 2023-25 to NHS England by 28 June 2023.