Policy paper

2022 to 2023 Better Care Fund policy framework

Updated 21 November 2022

Applies to England

Introduction

The government is committed to person-centred integrated care, with health, social care, housing and other public services working together to provide better joined up care. Enabling people to live healthy, fulfilled, independent and longer lives will require these services to work ever more closely together towards common aims. The response to the COVID-19 pandemic has accelerated the pace of collaboration across many systems and the government is keen to maintain momentum and build upon positive changes.

The Better Care Fund (BCF) is one of the government’s national vehicles for driving health and social care integration. It requires integrated care boards (ICBs) and local government to agree a joint plan, owned by the health and wellbeing board (HWB). These are joint plans for using pooled budgets to support integration, governed by an agreement under section 75 of the NHS Act (2006).

There are a number of upcoming reforms taking place to the health and social care system, including the Integration White Paper: Health and social care integration: joining up care people, place and populations, the Adult Social Care Reform White Paper, People at the Heart of Care; the Health and Care Act 2022 and reforms to the public health system which provide an important context for the BCF. This is set out in more detail in the sections below.

There will be limited change to the 2022 to 2023 Better Care Fund policy framework to provide continuity for systems during this transitional period. The framework will continue to build on progress made during the COVID-19 pandemic, strengthening the integration of commissioning and delivery of services and delivering person-centred care, as well as continuing to support system recovery from the pandemic. We will consult and engage with local areas on the future direction of the BCF beyond 2023 in the second half of 2022, taking into account the broader reforms.

One of the recommendations from the 2018 BCF Review was to more clearly align the Better Care Fund to addressing policy objectives that reflected priorities for health and social care integration, and that this should include a clear link to preventing need. BCF plans must include a clear approach for delivery against these 2 policy objectives in 2022 to 2023:

• enable people to stay well, safe and independent at home for longer

• provide the right care in the right place at the right time

National condition 4 of the BCF requires areas to agree a plan that sets out how health and social care will work together, and use BCF funding, to improve outcomes for each of these objectives.

We will undertake a full planning round in 2022 to 2023 with areas required to formally agree BCF plans and fulfil national accountability requirements. The 2022 to 2023 BCF Planning Requirements will set out further details of the national planning and assurance processes.

Funding

This Policy Framework confirms the conditions and funding for the BCF in 2022 to 2023.

Table 1 – Minimum contributions to the BCF in 2022 to 2023

BCF funding contributions	2022 to 2023 (£m)
Minimum NHS contribution	4,504
improved Better Care Fund (iBCF)	2,140
Disabled Facilities Grant (DFG)	573
Total	7,217

NHS minimum contribution to the BCF

Allocations from the NHS minimum contribution for each ICB and HWB have been published.

The government’s mandate to the NHS for 2022 to 2023, issued under section 13A of the NHS Act 2006, sets an objective for NHS England to ringfence £4.504 billion to form the NHS contribution to the BCF.

NHS England will consider taking action (including directing the use of the NHS minimum contribution), in consultation with the Department of Health and Social Care and the Department for Levelling Up, Housing and Communities where the national conditions are not met. These considerations apply to the NHS minimum contribution, and not to the amounts paid directly to local authorities from government. The expectation remains that, in any decisions around BCF plans and funding, ministers from both departments will be consulted.

We expect BCF plans to be submitted by 26 September.

The flexibility of local areas to pool more funding than the mandatory amount will remain.

As in previous years, the NHS contribution to the BCF will still include funding to support the implementation of the Care Act 2014, as well as funding previously earmarked for the provision of carers’ breaks. This is set out in the planning requirements. With particular reference to this funding, local areas will be asked to provide a brief overview on how BCF funding is supporting unpaid carers in their narrative plans. This supports the government’s recent commitments on empowering unpaid carers as set out in the Adult Social Care Reform White Paper: People at the Heart of Care.

Funding previously earmarked for reablement also remains in the NHS contribution.

Disabled Facilities Grant (DFG)

Funding for the DFG in 2022 to 2023 is £573 million. This is paid to local government through a section 31 grant. The DFG capital grant must be spent in accordance with an approved joint BCF plan, developed in keeping with this policy framework and the planning requirements.

As in previous years, in 2-tier areas, decisions around the use of the DFG funding will need to be made with the direct involvement of both tiers of local government (county and district councils) working jointly to support integration ambitions. Full details were set out in the DFG grant determination letter. The recent government white paper on adult social care reform stresses the importance of coordination and collaboration locally to ensure that people can access the right adaptations quickly. The government published updated guidance on 28 March 2022 that sets out how local authorities can effectively and efficiently deliver DFG funded adaptations to best serve the needs of local older and disabled people.

Funding for the DFG in 2023 to 2024 and 2024 to 2025 is also £573 million for both years.

Improved Better Care Fund (iBCF)

The total allocation of the iBCF in 2022 to 2023 is £2.14 billion. The iBCF grant determination was issued on 22 April 2022, with a condition that the grant is pooled into the area’s BCF plan. This funding does not replace, and must not be offset against, the NHS minimum contribution to adult social care.

BCF national conditions and metrics for 2022 to 2023

The national conditions for the BCF in 2022 to 2023 are:

• a jointly agreed plan between local health and social care commissioners, signed off by the HWB

• NHS contribution to adult social care at HWB level to be maintained in line with the uplift to NHS minimum contribution

• invest in NHS commissioned out-of-hospital services

• implementing the BCF policy objectives

National condition 1: a jointly agreed plan between local health and social care commissioners and signed off by the HWB

The local authority and ICB must agree a plan for their HWB area that includes agreement on use of mandatory BCF funding streams. The plan must be signed off by the HWB.

BCF plans should set out a joined-up approach to integrated, person-centred services across local health, care, housing and wider public services. They should include arrangements for joint commissioning, and an agreed approach for making progress towards the 2 policy objectives as part of the HWB area’s response to national condition 4 (below):

• enable people to stay well, safe and independent at home for longer
• provide the right care in the right place at the right time

This should include confirmation of how BCF funding will support this, and how this work will support the relevant national metrics.

National Condition 2: NHS contribution to adult social care to be maintained in line with the uplift to NHS minimum contribution

The 2021 Spending Review confirmed the NHS contribution to the BCF will rise in actual terms by 5.66% each year from 2022 to 2023 to 2024 to 2025. The NHS contribution for 2022 to 2023 will rise to £4.504 billion. Minimum contributions to social care will also increase by 5.66%. The minimum expectation of spending for each HWB area is derived by applying the percentage increase in the NHS contribution to the BCF for the area to the 2021 to 2022 minimum social care maintenance figure for the HWB.

These minimum expectations will be published alongside the BCF Planning Requirements. HWBs should review spending on social care, funded by the NHS contribution to the BCF, to ensure the minimum expectations are met, in line with the national condition.

National Condition 3: Invest in NHS commissioned out-of-hospital services

BCF narrative plans should set out the approach to delivering this aim locally, and how health and local authority partners will work together to deliver it.

Expenditure plans should show the schemes that are being commissioned from BCF funding sources to support this objective.

National condition 4: implementing the BCF policy objectives

This national condition requires areas to agree a joint plan to deliver health and social care services that support improvement in outcomes against the fund’s 2 policy objectives:

• enable people to stay well, safe and independent at home for longer
• provide the right care in the right place at the right time

As part of this national condition, commissioners should agree how services delivered via BCF funding sources will support these objectives. In meeting the first objective, areas should continue to focus on taking steps to promote independence, and address health, social care and housing needs of people who are at risk of reduced independence, including admission to residential care or hospital. In meeting the second objective, areas should continue to focus on making sure that people are supported to be discharged to the right place, at the right time, and with the right support that maximises their independence and leads to the best possible sustainable outcomes. This includes continued implementation of the High Impact Change Model for Transfers of Care, which is integral to meeting BCF requirements around supporting discharge.

Areas will also be required to agree and submit a plan showing expected demand for intermediate care services in the second half of the financial year, and expected capacity across the HWB area to meet this. These capacity and demand plans will need to be submitted at the same time as main BCF plans.

The intermediate care capacity and demand plans should cover intermediate care services which are funded by the BCF and also those services which are funded via other sources; there is no expectation that the BCF should be used to fund all services within the capacity and demand plan. As is the case with BCF plans, acute trusts and other providers will need to be involved in the development of these plans. Guidance on this is provided in the BCF Planning Requirements, and templates can be found on the Better Care Exchange.

Metrics

Beyond the 4 conditions (and grant conditions), areas have flexibility in how the fund is spent over health, care and housing schemes or services, but need to agree ambitions on how this spending will improve performance against the following BCF 2022 to 2023 metrics:

• avoidable admissions to hospital
• admissions to residential and care homes
• effectiveness of reablement
• hospital discharges that are to the person’s usual place of residence

From April 2022, the discharge ready date collected by hospital patient administration systems has become a required collection and will be used to collect better data on the date that people in acute hospital are ready to return home compared to the date of discharge. This will support the collection of more accurate data on delayed discharges.

A metric in relation to this data on delayed discharges will be adopted as a formal BCF metric from April 2023, as long as the data is robust and can be published. Systems should work together to ensure that this information is recorded accurately and for all patients as soon as possible. Systems will be asked to report, alongside the intermediate care capacity and demand plans, on progress in implementing full completion of the Ready for Discharge field and actions to ensure that data quality on discharge delays is accurate and completed in all cases to be able to provide an effective baseline for April 2023. Reducing length of stay remains a priority of the BCF. Through 2022 to 2023 data on length of stay will continue to be made available on HWB footprints. This data will be monitored regionally and nationally, with BCF support provided to systems facing most challenges.

Further detail is set out in the planning requirements.

Planning and assurance of BCF plans for 2022 to 2023

Plans will be developed locally in HWB areas by the relevant local authority and health commissioners. Plans must be agreed by the ICB (in accordance with ICB governance rules) and the local authority chief executive, prior to being signed off by the HWB.

Areas should look to align with other strategic documents such as plans for integrated care systems, wider community services programmes, and the implementation of adult social care reform. BCF partnerships will need to submit a narrative plan and a planning template, providing details of expenditure from BCF funding sources as well as ambitions and delivery plans for BCF metrics, signed off by the HWB. BCF plans will be assured and moderated regionally, as well as calibrated across regions. Following this, plans will be put forward for approval. Further information is set out in the BCF Planning Requirements for 2022 to 2023.

Local authorities are legally obliged to comply with section 31 grant conditions.

BCF and wider reforms in health and social care

COVID-19, and the experience of the system over the last few years, has demonstrated how important it is that health and care workers from different organisations are able to work together to deliver high quality care.

Since 2015, the BCF has been the government’s main policy lever for driving health and social care integration in England. In 2018, a review into the functioning and structure of the BCF, concluded that the BCF as a mandated pooled budget scheme has been effective in encouraging and incentivising areas to work together more effectively. Nevertheless, while immense progress has been made, the government is clear that it wants to go further and faster in building integrated services.

The Health and Care Act 2022, together with the recently published Health and Social Care Integration White Paper and Adult Social Care White Paper, set out a series of government ambitions on health and social care integration.

The Health and Care Act 2022

The Health and Care Act 2022 is intended to make joint working easier between the health service, social care, and local government. This act required the establishment of integrated care boards (ICBs) and the creation of integrated care partnerships (ICPs). The ICB will now exercise the commissioning functions, that have been exercised by clinical commissioning groups (CCGs) prior to being abolished, as well as some of NHS England’s commissioning functions. Integrated care partnerships will bring together health, social care public health and wider voluntary, community, and social enterprise representatives where appropriate. This will put more power and autonomy in the hands of local systems, to plan and deliver seamless health and social care services.

People at the Heart of Care: adult social care reform

In December 2021, the government published the People at the Heart of Care: Adult social care reform White Paper. This document sets out a range of policies that government will work with the sector and those who draw on care and support to implement over the next 3 years. The vision puts people at its heart and revolves around 3 objectives:

• people have choice, control and support to live independent lives
• people can access outstanding quality and tailored support
• people find adult social care fair and accessible

The white paper commits to new investment to enable all local areas to agree a plan embedding housing in broader health and care strategies (including investing in jointly commissioned services), as well as steps to ensure the DFG can benefit more people in need.

The integration white paper

On 9 February 2022, the government published the integration white paper, Health and social care integration: joining up care people, place and populations. It sets out plans to make integrated health and social care a reality for everyone across England and to level up access, experience and outcomes across the country. This includes proposals covering shared outcomes which prioritise people and populations; ensuring strong leadership and accountability; finance and integration, including aligned or pooled budgets; digital and data; and delivering integration through our workforce and carers.

Engagement with local areas on the implementation of the proposals set out within the integration white paper will continue throughout 2022 to 2023, including on the development of both the shared outcomes framework and guidance on the scope of pooled budgets. All places should also be working towards adopting a model of accountability which aligns with the criteria set out in the white paper by Spring 2023.

The future of the BCF

Later this year we will set out the policy framework for the BCF from 2023, including how the programme will support implementation of the new approach to integration at a place level, set out in the Health and Social Care Integration White Paper, as well as wider reforms set out above. We will consult and engage local areas in the development of this framework.