Hillingdon Council Cabinet Member and Officer Decisions
Better Care Fund Section 75 Agreement - PART II
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Democratic Services
Location: Phase II
Ext: 0693
DDI: 01895 250693
My Ref: SC
To: COUNCILLOR IAN EDWARDS
LEADER OF THE COUNCIL
COUNCILLOR JANE PALMER
CABINET MEMBER FOR HEALTH AND SOCIAL
CARE
c.c. All Members of Executive Scrutiny Committee
c.c. Tony Zaman, Social Care
c.c. Gary Collier, Social Care
c.c. Chairman of the Social Care, Housing and Public
Health Policy Overview Committee
c.c. Conservative and Labour Group Offices
(inspection copy)
Date:
05 March 2021
Non-Key Decision request Form D
BETTER CARE FUND SECTION 75 AGREEMENT
Dear Cabinet Member
Attached is a report requesting that a decision be made by you as an individual Cabinet
Member. Democratic Services confirm that this is not a key decision, as such the Local
Authorities (Executive Arrangements) (Meetings and Access to Information) (England)
Regulations 2012 notice period does not apply.
You should take a decision on or after Monday 15 March 2021 in order to meet
Constitutional requirements about publication of decisions that are to be made. You may
wish to discuss the report with the Corporate Director before it is made. Please indicate your
decision on the duplicate memo supplied, and return it to me when you have made your
decision. I will then arrange for the formal notice of decision to be published.
Steve Clarke
Democratic Services Officer
Title of Report: Better Care Fund Section 75 Agreement
Decision made:
Reasons for your decision: (e.g. as stated in report)
Alternatives considered and rejected: (e.g. as stated in report)
Signed ………………………………………………………Date……………………..
Leader of the Council / Cabinet Member for Health and Social Care
Cabinet Member Report – 5 March 2021 Page 1
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BETTER CARE FUND SECTION 75 AGREEMENT
Cabinet Member(s) Councillor Ian Edwards
Councillor Jane Palmer
Cabinet Portfolio(s) Leader of the Council
Cabinet Member for Health and Social Care
Officer Contact(s) Gary Collier, Social Care
Papers with report Appendix 1 – Section 75 Variation Form
HEADLINES
Summary
The Better Care Fund (BCF) is a mandatory process through which
Council and Hillingdon Clinical Commissioning Group (HCCG)
budgets are pooled and then reallocated on the basis of an
approved plan intended to achieve closer integration of health and
social care activities. This is intended to lead to improved outcomes
for residents. The BCF is also a route through which the
Government tar gets funding to support the local health and care
system.
The focus of Hillingdon's 2020/21 Better Care Fund plan is
improving care outcomes for older people, people with learning
disabilities and/or autism and children and young people. The
Council and HCCG are required to enter into an agreement under
section 75 of the National Health Service Act, 2006 to give legal
effect to the financial arrangements within the plan.
This report seeks delegated authority for the Leader of the Council
and the Cabinet M
ember for Health and Social Care to give final
approval to the section 75 agreement once it has completed the
mandated partnership approval process, i.e. sign- off by the Health
and Wellbeing Board.
Putting our
Residents First
This report supports the Council objectives of Our People.
The recommendation will also contribute to the delivery of the Joint
Health and Wellbeing Strategy.
Financial Cost The recommended total amount for the 2020/21 BCF is £103,427k,
this is made up of a Council contribution of £55,448k and a CCG
contribution of £47,979k.
Cabinet Member Report – 5 March 2021 Page 2
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Relevant Policy
Overview Committee
Social Care, Housing and Public Health Policy Overview
Committee
Relevant Ward(s) All
RECOMMENDATIONS
That the Leader of the Council and the Cabinet Member for Health and Social Care:
1. Approve the variation to the 2019/20 Better Care Fund agreement between the
London Borough of Hillingdon and Hillingdon Clinical Commissioning Group under
section 75 of the National Health Service Act, 2006, as described in the report.
2. Approve a variation to the contract between the London Borough of Hillingdon and
Central and North West London NHS Foundation Trust for the Integrated Therapies
for Children and Young People Service to include provision for a Speech and
Language Therapist in the Youth Justice Service at an annual cost of £70k.
Reasons for recommendations
Section 75 agreement variation - Using powers under the 2006 National Health Service Act,
NHSE makes the release of the £19,401k element of Hillingdon’s Better Care Fund that is under
its control conditional, on a pooled budget being established between the Council and Hillingdon
Clinical Commissioning Group (HCCG) through an agreement established under section 75 (s75)
of the National Health Service Act, 2002 (NHS Act).
In January 2021, Cabinet agreed to delegate authority to approve the terms of the s75 agreement
between the Council and HCCG. This was in response to the delay in the publication of the
Government’s requirements for the 2020/21 BCF plan and the requirement that the Health and
Wellbeing Board (HWB) approve financial arrangements. Utilising delegated authority, granted
by the Board to the Chairman, and the chairmen of HCCG’S Governing Body and Healthwatch
Hillingdon in September 2020, this national requirement has now been met.
The proposal to vary the 2019/20 s75 agreement reflects the COVID -19 Hospital Discharge
Service Requirements guidance, published on the 19th March 2020, and revised in April 2020
and the NHSE/I FAQ: Finance Support and Funding Flows published in April 2020. The variation
enables the Council to recover Covid-19 related expenditure incurred during 2019/20.
Variation to the Integrated Therapies for Children and Young People Service contract - The
variation will ensure that children and young people with physical, occupational and speech and
language difficulties, being supported by the Council’s Youth Justice Servic e, are offered an
assessment in accordance with national guidance and good practice, e.g. the Standards for
Children in the Youth Justice System, 2019. The post resulting from the variation will be jointly
funded by the Council and HCCG on 50:50 basis. The recommendation will ensure that this
provision is in place for the duration of the current contract, i.e., until 31
st July 2022.
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Alternative options considered / risk management
Not entering into the s75 agreement – The Leader and Cabinet Member could decide not to enter
the agreement with HCCG for 2020/21 but this is not recommended as it would impact on the
availability of £ 19,401k NHS funding to support the local health and care system, including
£
7,074k to protect adult social care. It could also impact on the £5,511k Disabled Facilities Grant
that is paid directly to the Council by the Ministry of Housing, Communities and Local Government
(MHCLG) and also the £7,248k Improved Better Care Fund Grant (iBCF) that is also paid directly
to the Council by the MHCLG. In each case grant conditions require that the Council has an
agreed BCF plan in place that meets national conditions. Having an agreed s.75 is one of the
national conditions.
Not agreeing to the variation to the Integrated Therapies for Children and Young People Service
contract - The Leader and Cabinet Member could decide not to agree to the variation. As the
proposal will enable the Council to comply with national guidance and address evidence from
studies that show the link between the number of people in criminal justice system relating to
behavioural issues associated with speech and language difficulties, this is not recommended.
Democratic compliance / previous authority
Cabinet on the 21 January 2021 provided delegated authority to the Leader of the Council and
Cabinet Member for Health and Social Care to approve the agreement between the Council and
Hillingdon Clinical Commissioning Group under section 75 of the National Health Service Act,
2006 for Hillingdon’s 2020/21 Better Care Fund plan.
Policy Overview Committee comments
None at this stage.
SUPPORTING INFORMATION
Background
The Better Care Fund (BCF) is a national initiative intended to deliver integration between health
and social care in order to improve outcomes for residents. It is the mechanism that is being used
by Government to implement the integration duty under the 2014 Care Act; the 2020/21 plan is
the sixth year and builds on the achievements of the four previous plans. The success of the BCF
in developing relationships across health and social care has assisted in the local response to the
Covid-19 pandemic.
The minimum amount required to be included within the BCF pooled budget for 2020/21 is
£31,761k. The proposed contribution is intended to be £ 103,427k, which would be £71,666k
above the minimum required to reflect local ambition. This is due to the inclusion of aspects of
service provision for children and young people and people with learning disabilities and/or autism
in 2019/20 that have been rolled forward into 2020/21. In addition, it includes additional NHS
funded service provision for enhanced hospital discharge support in response to the Covid- 19
Cabinet Member Report – 5 March 2021 Page 4
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pandemic. These are the final figures that have now been agreed by the CCG and, as previously
stated, the HWB.
For ease of reference the scheme headings are shown in table 1 below.
Table 1: BCF Schemes 2020/21
Scheme 1: Early intervention
and prevention.
Scheme 5: Improving care
market management and
development.
Scheme 2: An integrated
approach to supporting Carers.
Scheme 6: Living well with
dementia.
Scheme 3: Better care at end
of life.
Scheme 7: Integrated therapies
for children and young people
(CYP).
Scheme 4: Covid-19 hospital
discharge.
Scheme 8: Integrated care and
support for people with learning
disabilities and/or autism.
Scheme 4A: Integrating
hospital discharge and the
intermediate tier.
Section 75 Agreement Variation: Key Features
The report to the 21 January 2021 Cabinet meeting described the key features of the BCF plan
for 2020/21. The main features of the variation to the s75 agreement are as follows:
• Agreement duration: The term of the 2019/20 agreement will be extended to 31 st March
2021.
• Hosting and Pooled Budgets: Pooled budgets combine funds from different organisations
to enable them to secure better outcomes for residents. Since the start of the BCF there has
been a single pooled budget that has been hosted by the Council. However, the Covid -19
Hospital Discharge s and Out of Hospital Work: Financial Support and Funding Flows
Guidance (30/04/20) required a specific Covid-19 hospital discharge scheme to be created
with its own pooled budget and it is suggested that this be hosted by the CCG. This reflects
not only t he practice across NWL but is a practical approach in view of the complex
arrangements for drawing down funding to support Covid- related expenditure. The proposed
hosting arrangements for 2020/21 can be summarised as follows:
Schemes 1, 4A, 5, 6,7 and 8: The Council will continue to host as in previous years.
Scheme 4: The CCG will host.
Cabinet Member Report – 5 March 2021 Page 5
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• Risk share: The Council and CCG agreed that for previous iterations of BCF plans both
organisations would manage their own risks. It is intended that this approach continues for
2020/21.
• Dispute resolution: Any disputes will be referred to the Cabinet Member for Health and Social
Care and the Chairman of the HCCG Governing Body and will be final and binding.
• Delegations: The successful response to the Covid- emergency has necessitated a
delegation of functions between the Council and HCCG. This has included:
Delegation by the Council to the HCCG of its responsibility under the Care Act , 2014 to
secure nursing care home placements to address need.
Delegation by the CCG to the Council of its responsibility under the NHS Act, 2006, to
secure homecare provision to address the need of people whose care is funded by the
NHS.
• The detail of the delegation arrangements for the effective delivery of the schemes within the
BCF plan as required under the NHS Bodies and Local authority Partnership Arrangements
Regulations, 2000 are set out in Appendix 1.
• Governance: The delivery of the successive iterations of Hillingdon's plans has been
overseen by the Core Officer Group comprising of the Council's Chief Finance Officer, the
CCG's Deputy Chief Finance Officer, the Corporate Director of Social Care (a statutory
member of the HWB), the CCG's Joint Borough Directors and the Council's Head of Health
Integration and Voluntary Sector Partnerships . Revisions to governance arrangements for
2020/21 shown in Appendix 1 reflect the interrelationship between the HHCP Delivery Board
and the HWB as agreed by the latter at its September 2020 meeting.
Financial Implications
The sources and allocation of funding are set out in table 2 below:
Table 2: 2020/21 BCF Mandated Financial Requirements Summary
Item 2019/20
Income
2020/21
Income
%
Difference
DFG (LBH) 4,504,510 5,111,058 13.5
Minimum CCG contribution 18,361,811 19,401,312 5.7
iBCF (LBH) 6,207,140 7,248,248 0
Winter Pressures (LBH) 1,041,108
Minimum Total 30,114,569 31,760,618 5.7
To Adult Social Care from minimum CCG
contribution
6,695,773 7,074,835
5.7
NHS commissioned out of hospital services 5,217,906 5,513,302 5.7
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Table 3 below provides the breakdown of Council and CCG contributions in 2020/21 compared
with 2019/20.
Table 3: Financial Contributions by Organisation 2019/20
and 2020/21 Compared
Organisation 2019/20
(£,000s)
2020/21
(£,000s)
LBH 53,534 55,448
HCCG 39,418 47,979
TOTAL 92,952 103,427
Table 4 provides a breakdown of investment by the Council and the CCG in each scheme in
2020/21 compared to 2019/20.
Table 4: HCCG and LBH Financial Contribution by Scheme Summary
Scheme Financial Contribution
2019/20 2019/20
LBH
£000s
LBH
£000s
LBH
£000s
LBH
£000s
LBH
£000s
LBH
£000s
1 Early intervention and
prevention
3,280 2,659 5,939 3,759 2,661 6,420
2 An integrated approach to
supporting Carers
898 104 1,002 899 94 993
3 Better care at end of life 0 819 819 0 819 819
4 Covid Hospital Discharge N/A N/A N/A 2,411 815 3,226
4A Improved hospital discharge
and the intermediate tier
2,054 19,079 21,133 2,142 16,808 18,950
5 Improving care market
management and
development
9,813 14,599 24,412 7,598 17,011 24,609
6 Living well with dementia 30 342 372 30 349 379
7 Integrated therapies for
children and young people
441 2,231 2,672 501 2,306 2,807
8 Integrated care and support for
people with learning
disabilities and/or autism.
30,322 6,195 36,517 38,108 7,029 45,137
Programme Management 0 86 86 0 87 87
Total Partner Contributions 46,838 46,114 92,952 55,448 47,979 103,427
The Leader and Cabinet Member may wish to note that the CCG’s contribution to the Integrated
Therapies for Children and Young People Service contract (including the contribution to the
Speech and Language Therapist in the Youth Justice Service), i.e. £2,28 1k, will be paid directly
by them to CNWL during 2020/21 and the Council will not be invoiced for this amount. This follows
directions from NHSE to CCGs about financial arrangements with NHS providers during the
pandemic.
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Covid-19 and Hospital Discharge
During the Covid emergency period, i.e. the period between the 19th March and 31st August
2020, funding of costs incurred as a result of hospital discharges is from payments into a pooled
budget arrangement with the CCG, with any additional requirements met through the NHS Covid
grant. CHC and financial assessments were not conducted during this emergency period, so
NHS Covid grant funding covered the impact of the absence of client contributions during this
period for new or substantially revised packages.
In accordance with the Hospital Discharge Service: Policy and Operating Model guidance
published on 21st August, CHC and financial assessments resumed from the 1
st September 2020.
The guidance requires that hospitals and community health and social care partners should fully
embed discharge to assess (D2A) processes. New or extended health and social care support
from the 1 st September will be funded by the NHS for a period of up to six weeks following
discharge from hospital up to the 31st March 2021. During this six-week period a comprehensive
health and care assessment will need to be undertaken to determine ongoing care needs.
Responsibility for funding any on-going care provision will also need to be determined during this
period. The Council has continued to approach this arrangement on a cost neutral basis in line
with previously budgeted allocations.
Following discussions between CCGs and local authorities within the North West London sector
regarding the apportionment of costs during the pandemic it has been agreed that the Council will
pay a flat rate contribution of £200.91k per month, which equates to the Council’s Adult Social
Care budget of £2,411k and therefore the cost neutral position referred to above. This is reflected
in the variation to the s75 agreement and can be seen in Appendix 1.
The Council's contributions to the Pooled Budgets are contained within the overall budget for the
Council and includes budgets from Social Care, r esident facing services and administration
departments.
RESIDENT BENEFIT & CONSULTATION
The benefit or impact upon Hillingdon residents, service users and communities
The Council and HCCG will be able to comply with the 2020/21 BCF national requirements.
Consultation carried out or required
HCCG has been consulted on the content of this report.
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CORPORATE CONSIDERATIONS
Corporate Finance
Corporate Finance has reviewed this report and associated financial implication, noting the
funding split laid out in the table referenced above and confirm that this is consistent with the both
Council’s Budget Monitoring and MTFF position.
Legal
The Borough Solicitor confirms that the legal implications are included in the body of the report.
BACKGROUND PAPERS
• Cabinet report – 21 January 2021
• Better Care Fund: Policy Statement, 2020 to 2021 (DHSC Dec 2020)
• COVID-19 Hospital Discharge Service Requirements (March, April & September 2020)
• FAQ: Finance Support and Funding Flows (NHSE/I April 2020)
• The Royal College of Speech and Language Therapists: Justice Evidence Base
Consolidation: 2017
TITLE OF ANY APPENDICES
Appendix 1 – Section 75 Variation Form
Page 1 of 38
Contract Variation Form
Contract ref: 424675
Company: Hillingdon Clinical Commissioning
Group
Service: Agreement under section 75 of the NHS
Act, 2006 for the 2019/20 Better Care Fund
Provided Services and Commissioned Care
Adult, Children and Young People's Services
T.01895 250730
gcollier@hillingdon.gov.uk www.hillingdon.gov.uk
London Borough of Hillingdon,
4S/01, Civic Centre, High Street, Uxbridge, UB8 1UW
APPENDIX 1 – SECTION 75 VARIATION FORM
Page 2 of 38
CONTRACT VARIATION FORM
CONTRACT REFERENCE NUMBER: 424675
CONTRACT VARIATION NUMBER:
This Contract Variation Form is issued as an amendment to the above Contract as per
Procurement & Contracts Standing Orders: Schedule H – Clause 8. All other Terms and
Conditions remain as stated in the original Contract.
This Agreement is made on the day 2021.
WHEREAS:
(A) The London Borough of Hillingdon and Hillingdon Clinical Commissioning Group (NHS
Hillingdon) entered into an agreement under section 75 of the National Health Service Act,
2006, in respect of the 2017/19 Better Care Fund on the 30
th day of January 2020 (the
“Agreement”).
(B) The Parties have agreed to amend the Agreement as detailed in this variation to take effect
from the 19th March 2020 (the “Effective Date”).
(C) The Parties exercise their rights to vary the Agreement in accordance with clause 29 of the
Agreement.
AMENDMENTS TO THE AGREEMENT
1. AMENDMENT 1: DEFINED TERMS AND INTERPRETATION
1.1 To amend Defined Terms and Interpretation by inserting as follows:
1.1.1 Better Care Fund Plan means for 2020/21 the schemes described in Schedule 1.
1.1.2 Covid-19 Pooled Fund means as described in Schedule 1D
1.1.3 Pooled Fund Manager means the Section 151 (Local Government Act, 1972) officer
of the Council, who is the Corporate Director of Finance or the Accountable Officer of
the CCG or their authorised representative, dependent on context.
2. AMENDMENT 2: TERM
2.1 Clause 2.2 shall be amended to read:
2.2 This Agreement shall continue until the 31st March 2021 or in accordance with Clause
21.
3. AMENDMENT 2: FUNCTIONS
3.1 To add new clauses 5.6 to 5.10 as follows:
Page 3 of 38
5.6 For the purposes of implementing the Schemes in Schedule 1, the CCG delegates to
the Council its functions below:
5.6.1 section 3(1)(b) of the 2006 Act of arranging for the provision of other
accommodation for the purpose of any service provided under the 2006 Act;
5.6.2 section 3(1)(e) of the 2006 Act of arranging for the provision of such other
services or facilities for the prevention of illness, the care of persons suffering
from illness, and the after -care of persons who have suffered from illness as
are appropriate as part of the health service.
5.7 Table 1 below shall describe the form that the delegation provided for in Clause 5.6
above shall take.
Table 1: Summary of Form of Delegated Functions: CCG to Council
Scheme Functions Delegated
Scheme 1 None
Scheme 2 None
Scheme 3 None
Scheme 4 a) Delegation by the CCG to the Council to
undertake the brokerage function for
homecare placements for adults and children
on behalf of the CCG as described in
Schedule 1D of this Agreement.
b) Delegation by the CCG to the Council to enter
into contractual arrangements with homecare
providers on behalf of the CCG.
c) Delegation by the CCG to the Council to
procure the provision of beds for use as
intermediate care on behalf of the CCG as
described in Schedule 1D of this Agreement.
d) Delegation by the CCG to the Council
authority to act as lead commissioner on
behalf of the CCG for the Discharge to Assess
(D2A) Service described in Schedule 1D.
Scheme 4A a) Delegation by the CCG to the Council
authority to enter contractual arrangements
with homecare providers on behalf of the
CCG.
b) Delegation by the CCG to the Council
authority to undertake assessment and
prescription of community equipment to meet
health needs.
c) Delegation by the CCG to the Council to act
as lead commissioner on behalf of the CCG
Page 4 of 38
for the community equipment service as
described in Schedule 1B.
Scheme 5 Delegation by the CCG to the Council to manage
the process for people registered with Hillingdon
GPs to access Personal Health Budgets as
described in Schedule 1C of this Agreement.
Scheme 6 None
Scheme 7 a) Delegation by the CCG to the Council to
exercise on its behalf lead commissioning
functions for the Children and Young People's
Integrated Therapy Service as described in
Schedule 1E of this Agreement.
b) Delegation by the CCG to the Council to
undertake all necessary steps for the
implementation of Scheme 7 in accordance
with the terms of Schedule 1E and the
agreed contract for the provision of the
Service.
Scheme 8 a) Delegation to the Council by the CCG the
case management function for people with a
learning disability and/or autism assessed as
being eligible for NHS Continuing Healthcare
(CHC) funding as described in Schedule 1F
of this Agreement.
b) Delegation to the Council by the CCG to act
as lead commissioner in securing care and
support to meet the assessed needs of
people with a learning disability and/or autism
eligible for CHC funding.
5.8 For the purposes of implementing the Schemes as described in Schedule 1 the Council
delegates its functions under section 2 (1) of the Care Act, 2014, to the CCG as follows:
5.8.1 Arrangements for the provision of services, facilities or resources, or take
other steps that will:
a) Contribute towards preventing or delaying the development by adults in its
area of needs for care and support;
b) Contribute towards preventing or delaying the development by carers in its
area of needs for support;
c) Reduce the needs for care and support of adults in its area;
d) Reduce the needs for support of carers in its area.
5.9 Table 2 below shall describe the form that the delegation provided for in Clause 5.8
shall take.
Page 5 of 38
Table 2: Summary of Form of Delegated Functions: Council to CCG
Scheme Functions Delegated
Scheme 1 None
Scheme 2 None
Scheme 3 None
Scheme 4 a) Delegation to the CCG by the Council to
undertake the brokerage function for nursing
care home placements for adults and children
on behalf of the CCG as described in
Schedule 1D of this Agreement.
b) Delegation to the CCG by the Council to enter
into contractual arrangements with nursing
care home providers on behalf of the CCG.
Scheme 4A Delegation to the CCG by the Council authority
to undertake assessment and prescription of
community equipment to meet social care
needs.
5.10 The Partners agree that the delegation of functions under this Clause 5 will:
5.10.1 Likely lead to an improvement in the way in which these functions are
discharged; and
5.10.2 Will improve health and wellbeing.
4. AMENDMENT 3: ESTABLISHMENT OF A POOLED FUND
4.1 To add amend clause 7.1 to read as follows:
7.1 In exercise of their respective powers under Section 75 of the 2006 Act, the Partners
have agreed to establish and maintain Pooled Funds for revenue and capital
expenditure as set out in Schedule 1. For the avoidance of doubt, there shall be two
Pooled Funds and their scope shall be as follows:
7.1.1 Pooled Fund 1: Schemes 1, 2, 3, 4A, 5, 6 and 7.
7.1.2 Pooled Fund 2 (the ‘Covid-19 Pooled Fund’): Scheme 4.
4.2 To amend clause 7.6 to read as follows:
7.6 Pursuant to this Agreement, the Partners agree to appoint the Council as Host for
Pooled Fund 1 and the CCG for Pooled Fund 2 as set out in the Scheme
Specifications.
5. AMENDMENT 4: POOLED FUND MANAGEMENT
5.1 To amend clause 8.1 and 8.2 to read as follows:
Page 6 of 38
8.1 The Partners agree that the Council shall act as host for the purposes of Regulations
7(4) and 7(5) in respect of Pooled Fund 1 and the Council shall appoint an officer to
act as the Pooled Fund Manager for the purposes of Regulation 7 (4).
8.2 The Partners also agree that the CCG shall act as host for the purposes of Regulations
7(4) and 7(5) in respect of Pooled Fund 2 and the CCG shall appoint an officer to act
as the Pooled Fund Manager for the purposes of Regulation 7 (4).
6. AMENDMENT 5: NOTICES
6.1 To amend clause 28.3.2 to read:
28.3.2 if to the CCG, addressed to the Joint Borough Directors;
Tel: 01895 203005
E.Mail: sue.jeffers@nhs.net/richard.ellis9@nhs.net
7. AMENDMENT 6: SCHEDULE 1 – SCHEME DESCRIPTIONS
7.1 To replace Schedule 1 with Annex 1.
8. AMENDMENT 7: SCHEDULE 1A – FINANCIAL CONTRIBUTIONS SUMMARY
8.1 To replace Schedule 1A with Annex 2.
9. AMENDMENT 8: SCHEDULE 1B – OPERATION OF THE COMMUNITY EQUIPMENT
SERVICE
9.1 To replace Schedule 1B with Annex 3.
10. AMENDMENT 9: SCHEDULE 1D – OPERATION OF HOSPITAL DISCHARGE
ARRANGEMENTS
10.1 To replace Schedule 1D with Annex 4.
11. AMENDMENT 10: SCHEDULE 1E – INTEGRATED THERAPIES FOR CHILDREN AND
YOUNG PEOPLE
11.1 To expand definition of integrated therapies by inserting new clause 1.2.1A as follows:
1.2.1A A Speech and Language Therapist post to support the Council’s Youth Justice Service.
11.2 To replace table 2 associated with clause 8.1 as follows:
Page 7 of 38
Table 2: Integrated Therapies Funding Contributions 2019/21 Summary
Service Funder
LBH HCCG TOTAL LBH HCCG TOTAL
2019/20
(£,000)
2019/20
(£,000)
2019/20
(£,000)
2020/21
(£,000)
2020/21
(£,000)
2020/21
(£,000)
Integrated
therapies
441 2,231 2,672 441 2,246 2,687
SaLT in Youth
Justice Service
N/A N/A N/A 35 35 70
Designated
Clinical Officer
in SEND
N/A N/A N/A 25 25 50
TOTAL 441 2,231 2,672 501 2,306 2,807
11.3 To add a new clause 8.2 as follows:
8.2 For 2020/21 the CCG shall pay the Service Provider directly the CCG’s contribution to
the Integrated Therapies Service and SaLT in Youth Justice Service as shown in table
2 above.
12. AMENDMENT 11: SCHEDULE 1F – INTEGRATED CARE AND SUPPORT FOR
PEOPLE WITH LEARNING DISABILITIES.
12.1 To replace the table 1 linked to clause 2.1 of Annex B – Financial Arrangements, as
follows:
12.2 To replace the table 2 linked to clause to clause 6.1 of Annex B as follows:
Table 1: Charges to the CCG for LD Services 2020/21
Type FTE/Clients Rate Cost £
Case Management Service Costs
1. Staffing:
• Social Work (POB grade)
1.5 54,576 81,863
2. Accommodation & ICT 1.5 4,000 6,000
3. Additional staff support costs, e.g.
travel, training, admin, etc. N/A 5,000 5,000
4. Finance costs: payment of providers
and recharging CCG. 73 309 22,557
TOTAL COST
TOTAL COST: HOSTING LD HEALTH TEAM AND CASE
MANAGEMENT SERVICE 115,420
Page 8 of 38
Table 2: Scheme 8 Financial Contributions
Service Provider Funder 2019/20 Funder 2020/21
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
8.1 Social Care Staffing LBH 1,254 0 1,254 1,254 0 1,254
8.2 Homecare Various
P & V
904 0 904 840 167 1,007
8.3 Community Support Various
P & V
7,047 0 7,047 8,093 0 8,093
8.4 Supported Living Various
P & V
10,778 0 10,778 14,667 282 14,949
8.5 Residential/Nursing
Care Home Placements
Various
P & V
9,593 0 9,593 11,945 345 12,290
8.6 Respite placements LBH &
Various
P & V
746 0 746 1,309 64 1,372
8.7 CHC Placements Various
P & V
0 3,467 3,467 0 3,467 3,467
8.8 Non-CHC Placements Various
P & V
0 2,590 2,590 0 2,590 2,590
8.9 Accommodation &
Staffing
LBH 0 138 138 0 115 115
SCHEME 8 TOTAL 30,322 6,195 36,517 38,671 6,299 45,137
13. AMENDMENT 12: SCHEDULE 3 – BETTER CARE FUND GOVERNANCE
ARRANGEMENTS
13.1 To replace Schedule 3 with Annex 5.
14. AMENDMENT 13: SCHEDULE 4 - RISK SHARE AND OVER AND UNDER
PERFORMANCE
14.1 In respect of community equipment overspends to amend clause 2.2.2 to read as follows:
2.2.2 Where over expenditure occurs as a result of failure of one or more of the Partners
to abide by the terms of the Agreement, for example, through inappropriate
prescribing practice, the r elevant Partner shall bear full responsibility for that
overspend.
14.2 To insert a new clause 2.2A to read as follows:
2.2A With regards to Schedule 1D (Covid-19 Hospital Discharge), the Partners agree to
manage their own risks and benefits associated with the Scheme, except in respect of
new or additional costs as described in Annex A to the April Financial Reporting
Guidance that may be incurred by Social Care to support hospital disc harge or
admission avoidance during the Scheme 1 period as defined in Schedule 1D . These
costs will be met by the CCG and reclaimed from the Government.
Page 9 of 38
EXECUTION OF AGREEMENTS BY THE COUNCIL
CORPORATE SEAL of THE
LONDON BOROUGH OF HILLINGDON
was hereunto affixed in the presence of:
Date:
EXECUTION OF AGREEMENTS BY NHS HILLINGDON
NAME: ________________________
POSITION: _____________________
SIGNATURE: ______________________
DATE: ___________________
Page 10 of 38
Annex 1
Schedule 1 - Scheme Descriptions
Scheme 1: Early intervention and prevention
a) Scheme Aim(s)
To manage demand arising from demographic pressures by reducing the movement of
Hillingdon residents/patients from lower tiers of risk into higher tiers of risk through
proactive early identification and facilitating access to preventative pathways.
b) 2020/21 Priorities
The 2020/21 priorities under this scheme include:
• Maintain the H4All Covid-19 Hub to support shielded and self-isolating residents for
the duration of the pandemic.
• Subject to national Covid-19 guidance, reintroduce falls-prevention programmes.
• Subject to national Covid-19 guidance, provide opportunities for older people to
participate in sport and physical activity.
• Explore the increased application of assistive technology to support the
independence of residents in the community.
c) Intended Outcomes/Success Measures
This scheme will contribute to the following key BCF metric:
• Reduction in non-elective admissions.
Scheme 2: An integrated approach to supporting Carers
a) Scheme Aim(s)
This scheme seeks to maximise the amount of time that Carers are willing and able to
undertake a caring role.
This will be contributed to by Carers being able to say:
• "I am physically and mentally well and treated with dignity"
• "I am not forced into financial hardship by my caring role"
• "I enjoy a life outside of caring"
• "I am recognised, supported and listened to as an experienced carer"
b) 2020/21 Priorities
The 2020/21 priorities under this scheme are:
● The recruitment of Carer representatives to attend the Strategy Group.
● Development of a guide for people who become Carers unexpectedly.
● Ensuring that the identity of the Carers’ lead in each GP Practice is clearly displayed.
● Implementing the response to Carer feedback at the CCG’s October 2019 AGM in
respect of:
❖ Developing and implementing a strategy for addressing identified barriers to
Page 11 of 38
screening uptake;
❖ Supporting access to primary care by piloting a darsi/farsi speaking interpreter in
the south of the borough where there is greatest need;
❖ Co-design information for children with learning difficulties and/or autism and their
families, including Easy to Read guidance on accessing the health service
appropriately.
c) Intended Outcomes/Success Measures
This scheme will contribute to the following BCF national metrics:
a) Reduction in non-elective admissions.
b) Reduction in permanent admissions to care homes of 65 + population.
Scheme 3: Better care at end of life
a) Scheme Aim(s)
This scheme seeks to realign and better integrate the services provided to support people
towards the end of their life in order to deliver the ethos of a ‘good death.’ The main aims
are to:
• Ensure that people at end of life are able to be cared for and die in their preferred
place of care; and
• To ensure that people at end of life are only admitted to hospital where this is clinically
necessary or where a hospital is their preferred place of care or death.
b) 2020/21 Priorities
The 2020/21 priorities under this scheme are:
• Deliver an integrated model of care for people at end of life.
• Expand the use of the CNWL’s Your Life Line to provide End of Life rapid response
nursing assessments.
• Increase use of digital technology to connect people at end of life and their families.
c) Intended Outcomes/Success Measures
This scheme will contribute to the following key BCF metric:
• Reduction in non-elective admissions.
The following measure will also be used to identify whether the scheme is working:
• Proportion of people on an end of life pathway on CMC who achieved their preferred
place of death.
Page 12 of 38
Scheme 4: Covid-19 Hospital discharge
a) Scheme Aim
The key aim of this Scheme is to maintain capacity at Hillingdon Hospital to support
people requiring treatment in hospital for non-Covid related conditions.
b) 2020/21 Priorities
The 2020/21 priorities under this scheme are:
• Maintain range of Enhanced Discharge Services for the period of the pandemic
emergency.
c) Intended Outcomes/Success Measures
This scheme will impact on the following BCF metrics:
• Reduction in permanent admissions of older people aged 65 years and over to
residential and nursing care homes, per 100,000 population.
Scheme 4A: Integrated hospital discharge and the intermediate tier
a) Scheme Aims
The aims of this scheme are:
• To prevent admission and readmission to acute care following an event or a health
exacerbation;
• To enable recovery through intermediate care interventions to maximise a person’s
independence, ability to self-care and remain in their usual place of residence for as
long as possible;
• To support discharge from mental health community beds
b) 2020/21 Priorities
The 2020/21 priorities for this Scheme include:
• Completing the roll out of criteria-led discharge to all wards within Hillingdon
Hospital.
• Establishing a single point of coordination within Hillingdon Hospital for hospital
discharges, managed under a single, integrated management function.
• Establishing a point of coordination for access to community resources to build
up suitable packages of care and support.
• Developing and implement pathways with inclusion criteria that support the
discharge of patients on pathway 2.
• Reviewing all specialist pathways to include Frailty, End of Life and Palliative
Care to ensure these are aligned to the integrated discharge model.
Page 13 of 38
• Ensuring availability of sufficient step-down/step-up provision (bedded and non-
bedded) to meet winter demand surge requirements.
c) Intended Outcomes/Success Measures
This scheme will impact on the following BCF metrics:
• Reduction in permanent admissions of older people aged 65 years and over to
residential and nursing care homes, per 100,000 population.
Other success measures include:
• Daily bed occupancy rate at Hillingdon Hospital: The bed occupancy rate should
be at no more than 90%.
• Length of stay of seven days or more: Percentage of people in hospital with a
length of stay of seven days or more (known as ‘stranded patients’) should be no more
than 30% of the bed base, i.e. 90 based on 315 core beds.
• Weekend surplus of discharges (people admitted as emergencies) v admissions
(people admitted as emergencies) should be more than or equal to 1.
• Out of hospital capacity: Health and social care capacity at no more than 90%
utilisation
Scheme 5: Improving care market management and development
a) Scheme Aim(s)
This scheme is intended to contribute to the STP 2020/21 outcomes of achieving:
• A market capable of meeting the health and care needs of the local population within
financial constraints; and
• A diverse market of quality providers maximising choice for local people.
b) 2020/21 Priorities
The 2020/21 priorities under this scheme are:
• Coordinate access to most up to date information for CQC registered providers.
• Coordinate Covid-testing arrangements for care home staff and residents.
• Coordinate access to PPE for CQC registered providers.
• Embed wrap-around support for all care homes.
• Implement the new Community Based Care and Support Services contract.
• Complete integrated brokerage proposals and secure agreement on way forward post
Covid.
Page 14 of 38
c) Intended Outcomes/Success Measures
This scheme will contribute to the following national BCF metrics:
• Reduction in non-elective admissions
• Reduction in permanent admissions to care homes of 65 + population.
The following measures will be used to identify whether the scheme is working:
• Number of CQC registered care providers that experience business failure.
• Reduction in inappropriate non-elective admissions from extra care sheltered housing
schemes.
• Proportion of people on an end of life pathway on CMC who achieved their preferred
place of death.
Scheme 6: Living well with dementia
a) Scheme Aim(s)
The main aim of this scheme is that people with dementia and their family carers are
enabled to live well with dementia and are able to say:
• I was diagnosed in a timely way.
• I know what I can do to help myself
and who else can help me.
• Those around me and looking after me
are well supported.
• I get the treatment and support, best
for my dementia, and for my life.
• I feel included as part of society.
• I understand so I am able to make
decisions.
• I am treated with dignity and respect.
• I am confident my end of life wishes
will be respected. I can expect a good
death.
b) 2020/21 Priorities
The 2020/21 priorities under this scheme are:
• Develop training for care homes in how to manage people with challenging
behaviours.
• Enable people living with dementia to continue to live independently in our community
and feel supported and knowledgeable about where to access advice and help when
required.
c) Intended Outcomes/Success Measures
This scheme will impact on the following BCF metrics:
• Reduction in permanent admissions to care homes.
Page 15 of 38
Scheme 7: Integrated therapies for Children and Young People
a) Scheme Aims
This Scheme aims to:
• To provide a high quality service for children and young people with physical,
occupational and speech and language difficulties in accordance with national
guidance and best practice.
• To improve the quality of life and the ability of children and young people with
physical, occupational and speech and language difficulties to live independently or
with support within the community and participate in mainstream services including
education.
b) 2020/21 Priorities
The 2020/21 priority under this scheme is:
• To embed the implementation of the new integrated therapies model for children and
young people.
c) Intended Outcomes/Success Measures
This scheme will not contribute to the BCF metrics.
The measures that will be used to identify whether the scheme is working include:
• % of referrals acknowledged within 2 days of receipt (by email or text).
• % of referrals (reviewed by the MDT Panel) with referral decision communicated to the
referrer within 2 weeks.
• % of EHC needs assessment reports provided within 6 weeks (statutory) by therapy
type: SaLT, OT & physiotherapy.
• % of parents / carers satisfied with the timeliness of the identification of their child's
needs.
• % of parent / carers who report that the pathway process is clear and that they feel
involved in agreeing their child's intervention outcomes.
• Youth Justice SaLT: 100% of young people are offered a SaLT assessment within 2
weeks of referral being accepted.
• Youth Justice SaLT: 100% of all Pre-sentence Reports and Breach reports have SaLT
contribution.
• Youth Justice SaLT: 100% of young people are provided with a report and
communication profile outlining their strengths, needs and adaptations.
Scheme 8: Integrated care and support for people with learning disabilities and/or
autism
a) Scheme Aims
The intended aims of this Scheme are to:
Page 16 of 38
• To improve the quality of care for people with a learning disability and/or autism;
• To improve quality of life for people with a learning disability and/or autism;
• To support people with a learning disability and/or autism down pathways of care to
the least restrictive setting;
• To ensure that services are user focused and responsive to identified needs;
• To ensure Value for Money and efficient use of resources, maximising income where
at all possible and avoiding duplication.
b) 2020/21 Priorities
The 2020/21 priorities under this scheme are:
• Deliver new care and wellbeing service contracts for people with learning disabilities
and/or autism who are in a supported living setting.
• Complete implementation of the action plan from reviews completed between health
and social care under the Learning Disabilities Mortality Review Programme.
• Secure agreement on an integration model that will secure improved outcomes for
people with learning disabilities and/or autism for implementation from 2021/22.
c) Intended Outcomes/Success Measures
This scheme will not contribute to the BCF metrics.
The following measures will be used to identify whether the scheme is working:
• % of people with learning disabilities known to services in settled accommodation.
• % of people with learning disabilities known to services receiving an annual health
check.
• % of Service Users with an up to date Health Action Plan.
Page 17 of 38
Annex 2
SCHEDULE 1A - FINANCAL CONTRIBUTIONS SUMMARY
Figures in the tables within this Schedule are subject to rounding and therefore totals given may not be the
sum of the numbers provided.
TABLE 1: BCF FUNDING SUMMARY 2019/21 2019/20 2020/21
£,000s £,000s
Protecting Social Care 6,696 7,074
CCG Share of Minimum Contribution 11,666 12,320
TOTAL MINIMUM LEVEL OF BCF POOLED FUNDING 18,362 19,401
Disabled Facilities Grant 4,505 5,111
Additional Council Contribution 35,086 43,089
IBCF Section 31 Grant 6,207 7,248
Winter Pressures 1,041 0
Additional CCG Contribution 27,752 28,578
TOTAL BCF FUNDING 92,952 103,427
Table 2: Contract and Provider Breakdown
Scheme 1: Early intervention and prevention
Service Provider Funder 2019/20 Funder 2020/21
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
1.1 Wellbeing
Service
H4All 0 351 351 0 351 351
1.2 Dementia
Outreach Support
H4All 20 0 20 20 0 20
1.3 Falls Prevention Age UK 0 127 127 0 127 127
1.4 Integrated Care
Programme
HHCP 0 1,755 1,755 0 1,755 1,755
1.5 Care Connection
Teams
HHCP 0 332 332 0 332 332
1.6 Core Grant Age UK 582 0 582 582 0 582
1.7 Core Grant Dash 98 0 98 98 0 98
1.8 Core Grant Mind 80 0 80 90 0 90
1.9 MarketPlace Liquidlogic 0 45 45 45 45
1.10 Online Services
Coordinator
LBH 0 48 48 50 50
1.11 MOVES
Programme
LBH 20 0 20 0 0 0
1.12 Telecare - DFG LBH 360 0 360 360 0 360
1.13 Major
Adaptations -
DFG
LBH 2,120 0 2,120 2,726
0 2,726
SCHEME 1 TOTAL 3,280 2,659 5,939 3,876 2,661 6,537
Page 18 of 38
Scheme 2: An integrated approach to supporting Carers
Service Provider Funder 2019/20 Funder 2020/21
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
2.1 Carers' hub,
assessments
and reviews.
Carers
Trust
(lead)
659 0 659 659 0 659
2.2 Core grant Carers
Trust
105 0 105 105 0 105
2.3 Services to
Carers (inc
respite)
Various
P & V
0 85 85 0 75 75
2.4 Carer Support
Worker
Carers
Trust
0 19 19 0 19 19
2.5 Respite Breaks Harlington
Hospice
135 0 135 135 0 135
SCHEME 2 TOTAL 899 104 1,003 899 94 993
Scheme 3: Better care for people at end of life
Service Provider Funder 2019/20 Funder 2020/21
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
3.1 Palliative Home
Care
CNWL 0 557 557 0 557 557
3.2 Community
Palliative Team
CNWL 0 262 262 0 262 262
SCHEME 3 TOTAL 0 819 819 0 819 819
Scheme 4: Covid hospital discharge
Service Provider Funder 2019/20 Funder 2020/21
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
4.1 Residential
Placements (65+)
Various
P & V
N/A
934 0 934
4.2 Nursing
Placements (65+)
Various
P & V
508 0 508
4.3 Homecare (65+) Various
P & V
969 0 969
4.4 Step-down
Building A
Comfort
Care
Services
0 349 349
4.5 Step-down
Building B
LBH 0 81 81
4.6 D2A Comfort
Care
Services
0 385 385
SCHEME 4 TOTAL 2,411 815 3,226
Page 19 of 38
Scheme 4A: Integrated hospital discharge and the intermediate tier
Service Provider Funder 2019/20 Funder 2020/21
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
LBH
(£,000's)
HCCG
(£000's)
TOTAL
(£000's)
4A.1 Prevention of
Admission/Read
mission to
Hospital (PATH)
Service
H4All
(Age UK)
29 97 126 29 97 126
4A.2 Reablement
Team
LBH 0 1,328 1,328 0 1,328 1,328
4A.3 Reablement &
Hospital
Assessments
LBH 0 1,173 1,173 0 1,198 1,198
4A.4 Reablement
Physio
CNWL 0 70 70 0 70 70
4A.5 Residential
Placements (65+)
Various
P & V
0 922 922 0 0 0
4A.6 Nursing
Placements (65+)
Various
P & V
0 497 497 0 0 0
4A.7 Homecare (65+) Various
P & V
0 963 963 0 0 0
4A.8 D2A Comfort
Care
Services
0 239 239 0 252 252
4A.9 Continuing
Healthcare Social
Work post
LBH 0 0 0 0 45 45
4A.10 Step-down Flat -
Cottesmore
House
Paradigm
Housing
Group
0 50 50 50 50
4A.11 Community
equipment - DFG
Medequip
1,561 0 1,561 1,678 0 1,678
4A.12 Hospital
Discharge Grant -
DFG
Various
P & V
250 0 250 250 0 250
4A.13 Rapid Response CNWL 0 2,174 2,174 0 2,174 2,174
4A.14 Hawthorne
Intermediate Care
Unit (HICU)
CNWL 0 1,849 1,849 0 1,849 1,849
4A.15 Community
Rehab
CNWL 0 1
View Decision / Minutes Text
Capital Release Decision Notice – 19 March 2021 OFFICIAL DECISION NOTICE PUBLISHED BY DEMOCRATIC SERVICES ON 19 MARCH 2021 The Leader of the Council and the Cabinet Member for Health and Social Care have made the following decision today: 1. THE LEADER OF THE COUNCIL AND THE CABINET MEMBER FOR HEALTH AND SOCIAL CARE BETTER CARE FUND SECTION 75 AGREEMENT DECISION: FULL APPROVAL That the Leader of the Council and the Cabinet Member for Health and Social Care: 1. Approved the variation to the 2019/20 Better Care Fund agreement between the London Borough of Hillingdon and Hillingdon Clinical Commissioning Group under section 75 of the National Health Ser vice Act, 2006, as described in the report; 2. Approved a variation to the contract between the London Borough of Hillingdon and Central and North West London NHS Foundation Trust for the Integrated Therapies for Children and Young People Service to include provision for a Speech and Language Therapist in the Youth Justice Service at an annual cost of £70k; and 3. That following the receipt of additional information, that the agreement include an additional £30k contribution from the HCCG in respect of scheme 4, the Covid Hospital discharge scheme, which increases the total value of the agreement to £103,457k from £103,427k. REASONS FOR THE DECISIONS MADE The Better Care Fund (BCF) is a mandatory process through which Council and Hillingdon Clinical Commissioning Group (HCCG) budgets are pooled and then reallocated on the basis of an approved plan intended to achieve closer integration of health and social care activities. This is intended to lead to improved outcomes for residents. The BCF is also a route through which the Government tar gets funding to support the local health and care system. The focus of Hillingdon's 2020/21 Better Care Fund plan is improving care outcomes for older people, people with learning disabilities and/or autism and children and young people. The Council and HCCG are required to enter into an agreement under section 75 of the National Health Service Act, 2006 to give legal effect to the financial arrangements within the plan. Tony Zaman, Corporate Director Adults, Children & Young People Services Gary Collier, Social Care Capital Release Decision Notice – 19 March 2021 Upon receipt of additional information, the Leader and Cabinet Member also agreed to include within the fund an additional £30k contribution from the Hillingdon Clinical Commissioning Group to support early discharge from hospital and admission prevention. ALTERNATIVES CONSIDERED AND REJECTED The Leader and Cabinet Member could decide not to enter the agreement with HCCG for 2020/21 but this is not recommended as it would impact on the availability of £ 19,401k NHS funding to support the local health and care system, including £7,074k to prot ect adult social care. The Leader and Cabinet Member could decide not to agree to the variation. As the proposal will enable the Council to comply with national guidance and address evidence from studies that show the link between the number of people in criminal justice system relating to behavioural issues associated with speech and language difficulties, this is not recommended. FURTHER INFORMATION The detailed report relating to this decision is available to view here . DECISION AUTHORITY & IMPLEMENTATION Where required, these decisions have been taken under The Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012. These decisions, unless called in, will come into effect from 5pm on Friday 26 March 2021. This is the formal notice by the Council of the above decisions. If you would like more information on any of the decisions, please contact Democratic Services on 01895 250636. The right hand column indicates the name of the officer(s) responsible for implementing / following up the decision in each case. Circulation of this decisions sheet is to a variety of people including Members of the Council, Corporate Directors, Officers, Group Secretariats and the Public.