News

Former £1bn BCF ‘performance fund’ replaced with delayed transfer plans

The government has decided to scrap the “time-consuming and bureaucratic” performance element of the Better Care Fund (BCF), instead replacing it with the requirement that local areas fund NHS-commissioned out-of-hospital services and develop an action plan to manage high levels of delayed transfers of care.

In a policy paper published last week, the Department of Health revealed it would remove the £1bn conditional ‘payment for performance’ framework it had originally tied to the BCF – which could ultimately allow the government to refuse cash to areas that fail to cut emergency admissions.

While developing the framework, the department said it came across strong feedback from local areas of “the need to reduce the burden and bureaucracy” in operating the fund, the government’s new £5.3bn flagship scheme to promote health and care integration.

Last month, healthcare industry leaders from the Chartered Institute of Public Finance and Accountability and the Healthcare Financial Management Association said more needed to be done to simplify the “unwieldy” Fund process and its unrealistic expectations.

In an effort to streamline and simplify the planning and assurance elements of the payment for performance fund in 2016-17, it determined that local areas must instead invest in a wide range of NHS-commissioned services, including social care, in out-of-hospital settings.

The alternative option is to put an “appropriate proportion” of their share of the £1bn performance fund into a “local risk-sharing agreement” as part of contingency planning “in the event of excess activity”. The balance would also be spent on NHS out-of-hospital services, with areas seeking to maintain the provision of these services consistent with 2015-16.

But the policy paper also touched on the “unacceptable high levels” of delayed transfers currently, demanding that each local area must develop a focused local action plan to manage these figures, including a locally-agreed target.

This target must be agreed between the local CCG, local authority and relevant acute and community NHS trusts, with the figure then reflected in CCG operational plans. The metric for the target should be the same as the national performance metric, which states an average delayed transfers of care per 100,000 people per month (attributable to either the NHS, social care or both).

In drafting these plans, local areas must consider the use of local risk-sharing agreements referencing existing NHS England and Local Government Association guidance, especially in regions where delayed transfers of care levels are “high and rising”.

Plans must also set out clear responsibility, accountabilities, measures of assurance and monitoring, as well as demonstrate how activities across the whole health and care sphere can support improved patient flow and admissions avoidance. All community capacity should be effectively used to support safe and effective discharge, the department said.

This new condition of the £1bn funding pot is based on the principle that CCGs, councils and local trusts will work closely and collaboratively on this key issue.

(Top image: c. Design Council and Andy Smith)