Hillingdon Council Cabinet Member and Officer Decisions
Better Care Fund Section 75 Agreement Extension
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Democratic Services
Location: Phase II
Ext: 0185
DDI: 01895 250185
CMD No: 1267
To: COUNCILLOR IAN EDWARDS
LEADER OF THE COUNCIL
COUNCILLOR JANE PALMER
CABINET MEMBER FOR HEALTH AND SOCIAL
CARE
c.c. All Members of the Health and Social Care Select
Committee
c.c. Gary Collier – Adult Social Care and Health
c.c. Sandra Taylor – Corporate Director Adult Social
Care and Health
Date: 5 December 2024
Non-Key Decision request Form D
BETTER CARE FUND SECTION 75 AGREEMENT EXTENSION
Dear Cabinet Members,
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 Friday 13 December 2024 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.
Liz Penny
Democratic Services Officer
Title of Report: Better Care Fund Section 75 Agreement Extension
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
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BETTER CARE FUND SECTION 75 AGREEMENT EXTENSION
Cabinet Member(s) Cllr Ian Edwards
Cllr Jane Palmer
Cabinet Portfolio(s) Leader of the Council
Cabinet Member for Health and Social Care
Officer Contact(s) Gary Collier – Adult Social Care and Health
Papers with report Appendix 1 – Variation to 2023/24 Better Care Fund Section 75
Agreement
HEADLINES
Summary
The Better Care Fund (BCF) is a mandatory process through which
Council and North West London Integrated Care Board (ICB)
budgets are pooled and then reallocated on the basis of an
approved plan intended to support residents to live healthy,
independent, and dignified lives through joining up health, social
care, and housing services seamlessly around the person. The BCF
is also a route through which the Government targets funding to
support the local health and care systems.
The focus of Hillingdon's 2024/25 Better Care Fund plan is
improving care outcomes for older people, adults living with long-
term conditions and people with learning disabilities and/or autism.
The Council and the ICB are required to enter into an agreemen t
under section 75 of the National Health Service Act 2006 for
2024/25 in order to give legal effect to the financial and partnership
arrangements within the plan.
This report seeks to extend the agreement between the Council and
the ICB approved by Cabinet in November 2023 for the 2023/24
plan and to vary its terms to reflect changes to the plan for 2024/25.
Putting our Residents
First
Delivering on the
Council Strategy
2022-2026
This report supports our ambition for residents / the Council of:
• Live active and healthy lives.
• Staying independent for as long as they are able.
This report supports our commitments to residents of:
• Thriving, Healthy Households
This report will contribute to delivery of priorities within the 2022-
2025 Joint Health and Wellbeing Strategy.
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Financial Cost Total amount for the BCF for 2024/25 is £100,025k , made up of a
Council contribution of £70,173k and an ICB contribution of
£29,852k.
Relevant Select
Committee
Health and Social Care
Wards All
RECOMMENDATIONS
That the Leader of the Council, in consultation with the Cabinet Member for Health &
Social Care:
1. Approve the extension to the 2023/24 Better Care Fund agreement between the Council
and the North West London Integrated Care Board (NHS North West London/ICB) under
section 75 of the National Health Service Act 2006 approved by Cabinet in November
2023 to cover the period from 1
st April 2024 to 31 st March 2025 at a value of
£100,025,164.
2. Approve the variation to the 2023/24 Better Care Fund agreement between the Council
and the North West London Integrated Care Board under section 75 of the National
Health Service Act, 2006, as described in this report.
3. Delegate to the Corporate Director of Adult Social Care and Health authority to amend
the terms of the agreement with NHS North West London during 2024/25 , in
consultation with the Leader of the Council and the Cabinet Member for Health and
Social Care.
Reasons for recommendations
1. Extension of Section 75 agreement: At its meeting in November 2023, Cabinet delegated
authority to the Leader of the Council with the Cabinet Member to extend the section 75 (s75)
agreement for 2024/25 and a one-year extension is permitted under the 2023/24 agreement.
2. The Leader and Cabinet Member are advised that NHS England makes the release of the
£24,164k element of Hillingdon’s Better Care Fund (BCF) that is under its control conditional
on a pooled budget being established between the Council and North West London Integrated
Care Board (ICB) through an agreement established under section 75 (s75) of the National
Health Service Act 2006 (NHS Act). This is in accordance with its powers under the Health
and Social Care Act 2012.
3. Local authorities and ICBs can enter into s75 agreements once written notification has been
received from NHS England that plans have ‘assured’ status. Written confirmation of assured
status was received on 21
st August 2024.
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4. The Leader and Cabinet Member are being requested to approve the recommendations in
this report at such a late stage in the year as a result of a timetable set by the Department of
Health and Social Care (DHSC). This is consequently not a matter that the Council has any
control over.
5. Variation to the 2023/24 BCF s75 agreement: The 2024/25 BCF is largely a roll forward of
that for 2023/24 and therefore much of the s75 remains the same; however, there are some
changes, and these are detailed in this report. Approval of the recommendation will therefore
ensure that the agreement addresses the necessary changes for 2024/25, including
amendments to financial arrangements. The detail s of the proposed changes to the
agreement are set out in variation form attached as Appendix 1.
6. Delegated authority to amend s75 agreement in -year: Th is delegated authority
recommendation will enable the Council and ICB to respond quickly to any opportunities
presented by evolving national policy, such as additional funding.
Alternative options considered / risk management
7. Not extending the s75 agreement: The Leader and Cabinet Member could decide not to
extend the 2023/24 agreement to cover 2024/25 BCF plan arrangements. This is not
recommended as it would impact on the availability of £24,869k in 2024/25 NHS funding to
support the local health and care system, including £8,812k to protect adult social care. It
could also impact on the £5,575k Disabled Facilities Grant (DFG) that is paid directly to the
Council by the Ministry of Housing, Communities and Local Government (MHCLG) and also
the £7,468k Improved Better Care Fund Grant (iBCF) that is also paid directly to the Council
by MHCLG. In each case, grant conditions require that the Council has an agreed BCF plan
in place that meets national conditions, one of which is having a s75 agreement in place.
8. Not delegate authority to amend s75 agreement in-year: The Leader and Cabinet Member
could decide not to approve delegation arrangements or to add some additional requirements.
This option is not recommended as the recommendation is intended to create agility within
the health and care system to respond to evolving circumstances, including new funding
opportunities.
Select Committee comments
9. None at this time.
SUPPORTING INFORMATION
Background
10. The Better Care Fund (BCF) is a national initiative intended to deliver integration between
health and social care to improve outcomes for residents. The Leader and Cabinet Member
are reminded that Department of Health and Social Care’s vision for the BCF is that it supports
people to live healthy, independent, and dignified lives through joining up health, social care,
and housing services seamlessly around the person. The vision is underpinned by the
following national objectives:
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• National BCF Objective 1: Enable people to stay well, safe, and independent at home
for longer.
• National BCF Objective 2: Provide the right care in the right place at the right time.
11. The BCF is also a mechanism that is being used by the Government to implement the
integration duty under the Care Act 2014.
12. The broad principles to be followed for the 2024/25 Better Care Fund (BCF) plan were set out
in the policy framework published on 12th April 2024. The detailed planning requirements for
2024/25 were also published on the same date. The plan developed in 2023/24 was intended
to cover a two-year period and the policy framework and planning requirements published in
April 2024 were intended as an addendum to what was agreed last year. The 2023/25
narrative plan that was submitted as required in 2023/24 as well as the 2024/25 addendum
documents are available via the following link: Better Care Fund - Hillingdon Council
.
13. The minimum amount required to be included within the BCF pooled budget for 2024/25 is
£37,206k. The 2024/25 value approved by the Health and Wellbeing Board under delegated
arrangements is £100,025k, which is £58,483k above the minimum required and reflects local
ambition.
14. The minimum amount referred to in paragraph 13 includes the minimum contributions that
the ICB and the Council are required to make by law. For the ICB this includes minimum
contributions to support Adult Social Care (£8,811k in 2024/25) and to support health services,
particularly those assisting with hospital discharge (£15,352k in 2024/25). The minimum
contributions from the Council include Disabled Facilities Grant (DFG), which is £5,574k for
2024/25, and the Improved Better Care Fund (iBCF). This is £7,467k for 2024/25. DFG is
intended to enable residents living with disabilities to remain in their own homes by funding
adaptations to reflect their needs. The iBCF is used to contribute to support the costs of
providing long-term care to residents to whom the Council has a responsibility under the 2014
Care Act to address assessed care needs.
15. Other mandated funding streams within the BCF include the Discharge Fund, part of which
the Government pays directly to the Council (£1,744k in 2024/25) and the other to the ICB
(£2,590k in 2024/25). It is a requirement that this funding is used to manage seasonal
changes in demand to expedite discharge from hospital.
BCF Schemes 2024/25
16. There has been no change for 2024/25 to the schemes within the BCF plan. For ease of
reference, the scheme headings are shown in T able 1 below. The 2024/25 priorities within
each scheme can be found in Schedule 1 of the s75 agreement variation document attached
as Appendix 1.
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Table 1: 2024/25 BCF Schemes
Scheme 1: Neighbourhood development.
Scheme 2: Supporting carers.
Scheme 3: Reactive care.
Scheme 4: Improved market management and development.
Scheme 5: Integrated support for people with learning disabilities and/or autistic people.
ICB Review of BCF Schemes
17. An ICB-instigated review of BCF across the eight Health and Wellbeing Boards within the
North West London Integrated Care System (ICS) is in progress. This is intended to identify
how to better demonstrate value from BCF funding and achieve greater consistency and is
scheduled to produce recommendations as to achieve closer alignment of schemes across
the ICS, except where difference is justified by local needs. Recommendations arising from
the review are expected in the autumn. In the meantime, the Leader and Cabinet Member
are advised that the review has no financial impact for 2024/25.
Key Changes from 2023/24 Plan
18. The 2024/25 plan is largely a roll forward from 2023/24, except for the following key changes:
• NHS additional contribution reduction: The funding, i.e., £2,464k, for the H4All
Wellbeing Service, The Confederation Integrated Care Programme and Care
Connection Teams has been removed from the BCF. These services are continuing in
2024/25 but are subject to a separate review being undertaken by the ICB.
• Mental Health Adult Social Care capacity: A new mental health service manager post
within Adult Social Care will create increased capacity to improve the flow of hospital
discharge cases as well as reduce the length of time between reviews. This will be
funded from NHS additional contribution paid to Adult Social Care and is linked to the
capitalisation of community equipment.
• Commissioning infrastructure capacity: The intention is to create dedicated
commissioning posts with lead responsibility for carers, prevention and community
support services and bed- based services to address gaps identified in the self -
assessment against the CQC assurance framework for Adult Social Care. These posts
are funded from a combination of an increase in the minimum NHS contribution to the
protection of Adult Social Care and reprioritisation of existing funding. This will ensure
the increased effectiveness of the discharge of the Council’s market development and
management responsibilities under section 5 of the Care Act 2014.
• Step-down block contracts: Direct awards for 3 years in respect of Parkfield House
Nursing Home (10 beds) and Drayton Village Care Centre (5 beds) have been approved
by Cabinet. This followed an abortive competitive tender exercise in 2023/24. The
funding for these beds is across several income streams within the BCF.
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Section 75 Agreement Key Features
19. The s75 agreement is largely a roll forward from 2023/24; however, the main features are
summarised in this section.
20. Agreement duration: Subject to the recommendation to extend the 2023/24 agreement
being agreed, the term would be 1st April 2024 until 31st March 2025.
21. Hosting: The practice since the inception of the BCF has been for the Council to host the
pooled budget, which is the equivalent of a joint bank account.
22. Hospital discharge arrangements : Schedule 1D of the s75 agreement variation in
Appendix 1 sets out financial arrangements supporting hospital discharge. This includes
funding for short-term bed-based block contracts as well as financial arrangements for out -
of-hospital services that are not bed- based. It sets out services funded from the Disch arge
Fund as well as other funding streams within the BCF. The agreement allows for funding
arrangements for some services within the Schedule 1D to continue beyond 31
st March 2025,
subject to termination arrangements within the schedule, or a new s75 agreement being
established.
23. Risk share: It is proposed that the established practice of both partners managing their own
risks is extended to the 2024/25 plan.
24. Dispute resolution: The dispute provisions of the agreement have been rolled over from the
agreement supporting the 2023/24 BCF plan.
25. Governance: The delivery of the successive iterations of Hillingdon's plans has been
overseen by the Core Officer Group comprising of the ICB's Joint Borough Directors for
Hillingdon, the Council’s Corporate Director for Adult Social Care and Health, HHCP’s
Managing Director, and the BCF Programme Manager. The interrelationship between the
Core Officer Group and the other governance structures within Hillingdon’s health and care
system remains unchanged.
26. Community equipment : Arrangements concerning the use of Disabled Facilities Grant
(DFG) funding to capitalise the ICB’s contribution to the community equipment service budget
to support Adult Social Care services is described to provide clarity.
27. Financial and partnership arrangements outside of the BCF pooled budget : A new
Schedule 7 has been added to the Agreement and this includes a range of joint funding
arrangements in Children’s Services. The rationale behind this is to keep financial and
partnership arrangements within a single s75 arrangement to reduce the num ber of
governance documents that partners are required to reference. This affects the following:
• Designated Clinical Officer in Special Education Needs and Disabilities (SEND).
• Speech and Language Therapist in the Youth Offending Service.
• Children’s Integrated Therapy Service.
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Financial Implications
BCF Value 2024/25
28. The value of the BCF for 2024/25 as shown in T able 2 below increases from £96,535k in
2023/24 to £100,025k. The expenditure tab from the template submitted to NHSE can be
accessed via this link: Better Care Fund - Hillingdon Council
. This provides Cabinet with a
detailed breakdown of investment for 2024/25 that is within the scope of the 2023/24 section
75 agreement.
Table 2: Financial Contributions by Organisation
2023/24 and 2024/25 Compared
Organisation 2023/24
(£)
2024/25
(£)
NHS 29,658,745 29,851,857
LBH 66,875,873 70,173,307
TOTAL (£) 96,534,618 100,025,164
29. Table 3 below provides a breakdown of the mandated funding streams for the BCF and also
the additional voluntary contributions.
Table 3: Financial Contributions by Funding Stream 2023/24 and 2024/25
Compared
FUNDING SOURCE
FUNDING
2023/24
(£)
2024/25
(£)
Minimum NHS Contribution 22,869,590 24,164,009
Additional NHS Contribution 5,524,379 3,096,967
ICB Discharge Fund 1,264,776 2,590,881
NHS TOTAL (£) 29,658,745 29,851,857
Minimum LBH Contribution 12,578,861 13,042,692
Additional LBH Contribution 53,250,038 55,385,658
LBH Discharge Fund 1,046,974 1,744,957
LBH TOTAL (£) 66,875,873 70,173,307
TOTAL BCF VALUE (£) 96,534,618 100,025,164
30. Table 3 shows a 4.9% increase in the Council’s contribution to the BCF in 2024/25 compared
to a 0.65% increase by the ICB. The difference is attributed to a combination of:
• T he reduction in the ICB’s additional contribution of £2,464k as a result of the removal
of the services from the BCF set out in paragraph 18.
• A n increase in the mandated minimum local authority contribution.
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• A n increase in the local authority discharge fund allocation.
• T he Government requirement that the £2,154k underspend in the 2023/25 DFG
allocation be included within the additional local authority contribution.
31. Table 4 provides a breakdown of the minimum BCF financial contributions.
Table 4: BCF MINIMUM CONTRIBUTIONS SUMMARY 2023/25
Funding Breakdown 2023/24
(£)
2024/25
(£)
NHS MINIMUM CONTRIBUTION BREAKDOWN
• Protecting Adult Social Care 8,339,569 8,811,589
• Out of Hospital 6,489,889 6,866,726
• Other minimum spend 8,040,132 8,485,694
TOTAL (£) 22,869,590 24,164,009
LBH MINIMUM CONTRIBUTION BREAKDOWN
• Disabled Facilities Grant (DFG) 5,111,058 5,574,889
• Improved Better Care Fund (iBCF) 7,467,803 7,467,803
TOTAL (£) 12,578,861 13,042,692
MINIMUM BCF VALUE (£) 35,448,451 37,206,701
32. Table 5 below summarises the LBH and NHS contributions for the period of the 2023 to 2025
plan by scheme.
Table 5: ICB and LBH Financial Contribution by Scheme Summary
Scheme 2023/24 2024/25
LBH
(£,000)
NHS
(£,000)
TOTAL
(£,000)
LBH
(£,000)
NHS
(£,000)
TOTAL
(£,000)
1. Neighbourhood
development
3,052 3,025 6,077 5,527 640 6,167
2. Supporting carers 690 471 1,161 671 308 979
3. Reactive care 5,489 19,990 25,479 6,267 22,240 28,507
4. Improving care market
management and
development.
26,232 5,083 31,315 26,336 5,489 31.825
5. Integrated care and support
for people with learning
disabilities and/or autistic
people.
31,412 993 32,405 31,372 1,075 32,447
Programme Management 0 97 97 0 100 100
TOTAL (£,000) 66,875 29,659 96,534 70,173 29,852 100,025
Summary of Financial Changes
33. In summary, the main financial changes from the 2023/24 plan are:
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• Additional LBH contribution:
Scheme 1: An additional £2,154k has been added for major adaptations and
discretionary capital grants, which is the DFG underspend from 2023/24 and is
included in the LA additional at the direction of NHS England.
• Minimum NHS contribution to Social Care:
Scheme 3: CHC Social Work post (£20k). This enables the post already part-funded
from the NHS additional contribution to be made full-time.
Scheme 4: Commissioning infrastructure (£262.6k). This is intended to fund
commissioning leads for carers, prevention and community services, and bed- based
services. The intention is to address gaps identified in the self -assessment against
the CQC ASC assurance framework. This is funded partly from growth and partly from
changes to the delivery model for the Dementia Resource Centre.
• Additional NHS contribution to Social Care:
Scheme 1: Mental Health Service Manager (£100k). See Key Changes from 2023/24
Plan above.
Scheme 3: P3 Bed Coordinator post (£50k) . The main purpose of this role is to
manage flow from step-down provision.
Scheme 3: Step-down block (£20.7k).
34. Discharge Fund: This includes a component that is paid directly to the Council as a Section
31 grant by the MHCLG and an allocation by the ICB. The values are shown in Table 3 above.
The detailed breakdown of the uses of this funding are set out in Schedule 1D of the s75
agreement variation attached to this report as Appendix 1 . In summary, of the £2,590k
allocation to the Hillingdon HWB from the ICB discharge fund, it is expected £1,414k will be
transferred to the Council. £934k is for schemes to support winter demand on hospital beds.
35. Improved Better Care Fund (iBCF) : The iBCF funding is paid directly to the Council from
MHCLG under Section 31 of the Local Government Act 2003, with specific grant conditions,
including a requirement that the funding is pooled in the BCF. The grant conditions for
2024/25 are the same as for the last 4 years, namely that the funding is used for:
● Meeting adult social care needs;
● Reducing pressures on the NHS, including supporting more people to be discharged
from hospital when they are ready; and/or
● Ensuring that the local social care provider market is supported.
36. Table 4 above shows that the Hillingdon allocation 2024/25 will be maintained at the £7,467k
level it was in 2023/24. It is proposed to continue to commit the £220k uplift that the Council
received in its 2022/23 iBCF allocation to contributing to the costs of short -term placements
to support hospital discharge.
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37. As for the last four years, it is proposed to continue to use the remainder of the funding to
support the local care market, i.e., long-term placements. This will fund the annualised effect
of the fee uplifts as well as additional fee increases to reflect the financial pressures faced by
regulated care providers due to higher staff, energy, and supply costs.
38. Personal Health Budgets Service: The fixed rate per new cases charged to the ICB for
delivering this service on its behalf increases from £1,176 in 2023/24 to £1,229 for 2024/25.
The annual support cost charge will increase from £502 to £525.
39. Learning disabilities case management service: The cost to the ICB of the Council
delivering this service on its behalf increases from £128.7k in 2023/24 to £130.2k in 2024/25.
40. Financial and partnership arrangements outside of the BCF pooled budget: Funding
arrangements reflected in Scheduled 7 of the BCF s75 agreement variation attached as
Appendix 1 are shown in Table 6 below.
Table 6: Funding Arrangements Outside BCF Pooled Budget
2024/25 Funding Contributions Summary
Post ICB
Contribution
(£)
LBH
Contribution
(£)
Total Cost
(£)
Speech and Language
Therapist in the Youth Justice
Service
32,038 32,038 64,076
Children’s Integrated Therapy
Service
2,284,100 455,163 2,739,263
Total (£) 2,316,138 487,201 2,803,339
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RESIDENT BENEFIT & CONSULTATION
The benefit or impact upon Hillingdon residents, service users and communities
The Council and ICB will be able to comply with the national BCF requirements for 2023/24.
Consultation carried out or required
The ICB has been consulted in the drafting of this report. The HHCP Delivery Board will be
considering the provisions of the s75 at its meeting on 19
th September 2024.
CORPORATE CONSIDERATIONS
Corporate Finance
Corporate Finance has reviewed this report and associated financial implication, noting the funding
split laid out in the tables referenced above and confirm that this is consistent with both Council’s
Budget Monitoring and MTFF position for the Better Care Fund (BCF). The total amount for the
BCF for 2024/25 is £100m made up of Council contribution of £70m and an Integrated Care Board
contribution (ICB) of £30m.
Legal
Legal Services confirm that the Council is responsible for carrying out this function pursuant to
section 75 of the National Health Service Act 2006.
It is confirmed within this report that the 2023/24 section 75 agreement contains clauses allowing
for the proposed extension and variation. Thus, there are no legal impediments to the Council
following the recommendations set out in this report.
BACKGROUND PAPERS
Better Care Fund Policy Framework and Planning Requirements, 2024/25:
https://www.gov.uk/government/publications/better-care-fund-policy-framework-2023-to-
2025/addendum-to-the-2023-to-2025-better-care-fund-policy-framework-and-planning-
requirement
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Contract Variation Form
Contract ref: 425319
Company: North West London Integrated Care Board (NHS
North West London)
Service: Agreement under section 75 of the NHS Act, 2006
for the 2024/25 Better Care Fund
Appendix 1
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CONTRACT VARIATION FORM
CONTRACT REFERENCE NUMBER: 424675
CONTRACT VARIATION NUMBER:
This Agreement is made on the day 2024.
WHEREAS:
(A) The London Borough of Hillingdon and the North West London Integrated Care Board (NHS North
West London) entered into an agreement under section 75 of the National Health Service Act, 2006,
in respect of the 2023/24 Better Care Fund on the 9
th day of November 2023 (the “Agreement”).
(B) T
he Parties have agreed to amend the Agreement as detailed in this variation to take effect from the
1st April 2024 (the “Effective Date”).
(C
) The Parties exercise their rights to extend the Agreement in accordance with clause 2.3 of the
Agreement and also to vary its terms in accordance with its clause 29.
AMENDMENTS TO THE AGREEMENT
1. AMENDMENT 1: FUNCTIONS
1.1 To delete from table 1 to clause 5.7 as follows:
Table 1: Summary of Form of Delegated Functions: CCG to Council
Scheme Functions Delegated
Scheme 2 Delegation by the ICB to the Council to act as
lead commissioner on behalf of the ICB for the
Carer Support Service.
Hospital, Localities and Health Integration
Adult Social Care and Health
T.01895 250730
gcollier@hillingdon.gov.uk www.hillingdon.gov.uk
London Borough of Hillingdon,
4S/01, Civic Centre, High Street, Uxbridge, UB8 1UW
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2. AMENDMENT 2: COMMISSIONING ARRANGEMENTS
2.1 To add new clause 6.6 to read as follows:
6.6 Commissioning arrangements in respect of Schedule 7 of this Agreement shall be as
described in that Schedule.
3. AMENDMENT 3: FINANCIAL CONTRIBUTIONS
3.1 To add new clause 9.3 to read as follows:
9.3 Financial arrangements in respect of Schedule 7 of this Agreement shall be as described
in that Schedule.
4. AMENDMENT 4: SCHEDULE 1 – SCHEME DESCRIPTIONS
4.1 To replace Schedule 1 with Annex 1.
5. AMENDMENT 5: SCHEDULE 1A – FINANCIAL CONTRIBUTIONS SUMMARY
5.1 To replace Schedule 1A with Annex 2.
6. AMENDMENT 6: SCHEDULE 1B – OPERATION OF THE COMMUNITY EQUIPMENT SERVICE
6.1 To amend clause 6 (Financial Arrangements) of Schedule 1B as follows:
2024/24 Budget
6.2 The breakdown of the 2024/25 budget for the Service is shown in table 1 below.
TABLE 1: TCES 2024/25 BUDGET BREAKDOWN
Funder ELS Door
Entry
Systems
Minor
Adaptations
TOTAL Activity Cost
Increase
TOTAL
WITH
ACTIVITY/
EQUIPMENT
COST
UPLIFT
%
NHS 1,518,398 36,008 40,098 1,594,504 4,496 1,599,000 76%
LBH 479,403 9,854 19,280 508,537 14,652 523,189 24%
TOTAL 1,997,801 45,862 59,378 2,103,041 19,148 2,122,189 100%
6.3 In 2024/25 the Council will capitalise the NHS community equipment contribution shown in
table 1 above using Disabled Facilities Grant funding. The ICB agrees to pay to the Council
a sum of equivalent value to support Adult Social Care provision. The use of this funding
shall be as shown in table 2 below.
TABLE 2: REVENUE RELEASE BREAKDOWN
Cabinet Member Report – 5 December 2024 Page 15 of 35
Part I - Public
v1 05.08.24
Funding Use ICB Additional
Voluntary
Contribution
Reablement 791,235
Mental Health Service Manager 100,000
Discharge Pathway 3 Bed Coordinator 50,000
Step-down Block Contract 21,765
Hospital Discharge Approved Mental
Health Practitioner (AMHP) 70,153
Mental Health Hospital Discharge Social
Worker 52,403
Mental Health Discharge Floating Support 50,927
Learning Disability Placements 462,517
TOTAL 1,599,000
6.4 The cost of the Contract Operations Officer post and Hillingdon contribution to the lead local
authority (LA) role for the London Community Equipment Consortium will be met by the
Council in 2024/25, subject to the outcome of a CES funding review to be undertaken across
the North West London Integrated Care System (ICS). These costs for 2024/25 are shown
in table 3 below.
TABLE 3: STAFFING & LEAD
LA ROLE COST
Staffing Lead Authority
Role Cost
52,758 7,980
16,661 2,520
69,419 10,500
Budget Setting
6.5 The Council will propose a base CES budget for consideration by the Partners by end of
Q3 2024/25 and a proposed base budget for 2025/26 will be determined by the end of
February 2025. Prescribing Teams funded from the Pooled Budget will be notified of their
allocation.
6.6 The proposed budget will be subject to the outcome of an ICS review of contributions to
the CES to be undertaken in 2024/25.
6.2 To add a second sentence to clause 6.9 so that it reads as follows:
6.9 Provisions concerning over and under-spends are addressed in Schedule 4 of this Agreement.
Underspends on planned activity as shown in table 2 may be used to support other Adult Social
Care provision.
7. AMENDMENT 7: SCHEDULE 1C - OPERATION OF THE PERSONAL HEALTH BUDGETS
SERVICE
Cabinet Member Report – 5 December 2024 Page 16 of 35
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v1 05.08.24
7.1 To amend clause 6 (Funding) so that the fixed rate per new cases increases from £1,176 in 2023/24
to £1,229 for 2024/25. The annual support cost charge will increase from £502 to £525. Clause 6.1 of
Schedule 1C will therefore read as follows:
6.1 The ICB will pay a fixed rate per case to the Council for the administration of PHBs for the
duration of the Agreement. The fixed rate per new case for 2024/25 will be £1,229 with an
annual support cost charge of £525 per case thereafter. These rates will be subject to review
for 2025/26.
8. AMENDMENT 8: SCHEDULE 1D – OPERATION OF HOSPITAL DISCHARGE ARRANGEMENTS
8.1 To replace Schedule 1D with Annex 3.
9. AMENDMENT 9: SCHEDULE 1F – INTEGRATED CARE AND SUPPORT FOR PEOPLE WITH
LEARNING DISABILITIES.
9.1 To replace the table 1 linked to clause 2.1 of Annex A – Financial Arrangements, as follows:
Table 1: Learning Disability Case Management Service Costings 2024/25
Type FTE/Service
Users
Rate 2024/25 Cost
1. Staffing
• Social Worker (POB grade) 1.5 70,784 106,176
2. Accommodation & ICT 1.5 4,500 6,750
3. Additional staff support costs, e.g., travel, training,
admin, etc.
N/A 8,000 8,000
4. Finance cost: payment of providers & recharging
ICB
29 320 9,280
TOTAL LD CASE MANAGEMENT SERVICE COST 130,206
9.2 To replace the table 2 linked to clause to clause 6.1 of Annex B as follows:
Cabinet Member Report – 5 December 2024 Page 17 of 35
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v1 05.08.24
Table 2: Scheme 5 Financial Contributions Summary
Service Provider Funder 2024/25
LBH
(£)
NHS
(£)
TOTAL
(£)
8.1 Social Care Staffing LBH 1,254,000 0 1,254,000
8.2 Homecare Independent
Sector
865,200 223,290 1,088,590
8.3 Day opportunities Independent
Sector
2,800,600 0 2,800,600
8.4 Direct Payments Independent
Sector
2,506,000 0 2,506,000
8.5 Outreach Services Independent
Sector
2,581,000 0 2,581,000
8.6 Supported Living LBH & Independent
Sector
12,187,300 0 12,187,300
8.7 Residential/Nursing Care
Home Placements
Independent
Sector
9,178,273 536,825 9,715,098
8.8 Respite placements LBH & Independent
Sector
0 184,339 184,339
8.9 Case Management Service LBH 0 130,206 130,206
SCHEME 5 TOTAL 31,372,373 1,074760 32,447,133
10. AMENDMENT 1 0: SCHEDULE 7 - PARTNERSHIP ARRANGEMENTS EXTERNAL TO BCF
POOLED BUDGET
10.1 To insert new Schedule 7 attached as Annex 4.
Cabinet Member Report – 5 December 2024 Page 18 of 35
Part I - Public
v1 05.08.24
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 NORTH WEST LONDON
NAME: ________________________
POSITION: _____________________
SIGNATURE: ______________________
DATE: ___________________
Cabinet Member Report – 5 December 2024 Page 19 of 35
Part I - Public
v1 05.08.24
Annex 1
Schedule 1 - Scheme Descriptions
Scheme 1: Neighbourhood Development
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) 2024/25 Priorities
The 2024/25 priorities under this scheme include:
• Implementation of leadership and governance arrangements for six Integrated
Neighbourhood Teams.
• Integration of community nursing at Neighbourhood level.
• Integration of therapies at Neighbourhood level.
• Implementation of three Same Day Urgent Primary Care Hubs.
• Development and implementation of a third sector Neighbourhood offer.
• Improve dementia diagnosis rates.
c) Intended Outcomes/Success Measures
This scheme will contribute to the following key BCF metric:
• Unplanned admissions for ambulatory sensitive chronic conditions
(admission avoidance metric): Reduction in non-elective admissions of people
with ambulatory care sensitive conditions. The indirectly standardised rate of
admissions per 100,000 population should be 234.1.
• Permanent admissions to care homes by people aged 65 and over:
Reduction in permanent admissions to care homes per 100,000 65 + population.
The ceiling for 2024/25 is 320 admissions.
• Emergency hospital admissions due to falls in people aged 65 and over: The
ceiling for 2024/25 is 837 admissions.
Scheme 2: 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:
Cabinet Member Report – 5 December 2024 Page 20 of 35
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• "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) 2024/25 Priorities
The 2024/25 priorities under this scheme are:
• Consulting on the draft all-age 2024 – 2029 Joint Carers Strategy.
• Completing restoration of carer leads in GP surgeries.
• Establishing carer registers in 100% of GP practices that are members of The
Hillingdon [GP] Confederation.
• Reviewing the carers assessment process for parent carers and young carers.
• Retendering the Carer Support Services contract.
• Explore options for increasing the percentage of adult carers supported by the
Council having needs met via Direct Payments.
• Supporting schools to develop their own support provision for young carers.
• Refresh the Memorandum of Understanding between health and care partners on
an integrated approach to identifying and assessing carer need in Hillingdon.
c) Intended Outcomes/Success Measures
This scheme will contribute to the following BCF national metrics:
• Admission avoidance metric: Reduction in non-elective admissions of people
with ambulatory care sensitive conditions. See scheme 1.
• Percentage of people who are discharged from acute hospital to their usual
place of residence: The percentage of Hillingdon residents aged 18 and above
discharged to their usual home. See scheme 3.
• Permanent admissions to care homes metric: See scheme 1.
Scheme 3: Reactive Care
a) Scheme Aims
The aims of this scheme are to provide a co-ordinated time limited same day
community based response to:
Cabinet Member Report – 5 December 2024 Page 21 of 35
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• Unplanned rapid physical and/or mental health deterioration in the health of a
patient with complex needs or multiple long term conditions in order to prevent
unnecessary hospital admission/ED attendance and/or premature admission to
long-term care.
• Promote faster recovery from acute (mental) illness, in order to support timely
discharge from hospital and maximise independent living.
b) 2024/25 Priorities
The 2024/25 priorities for this Scheme include:
• Implementing the new End of Life Coordination Hub Operating Model.
• Implementation of an Integrated Active Recovery Service.
• Implementation of ‘Maximising HomeFirst’ programme to reduce length of stay.
• Establishing block contracts for pathway 3 discharges.
c) Intended Outcomes/Success Measures
This scheme will impact on the following BCF metrics:
• Discharge to usual places of residence: This is the percentage of people aged
18 and above discharged from hospital to their usual place of residence. The
target for 2024/25 is 91.7%.
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 (Hillingdon Hospital): 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.
• Out of hospital capacity: Health and social care capacity at no more than 90%
utilisation.
Page 22 of 35
Scheme 4: Improving care market management and development
a) Scheme Aim(s)
This enabling scheme supports other schemes within the BCF and aims to
achieve:
• 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) 2024/25 Priorities
The 2024/25 priorities under this scheme are:
• Implementing a coordinated approach to supporting the sustainability of the
regulated care market.
• Implementing Market Sustainability Plan in respect of care homes for people
aged 65 + and providers of homecare for people aged 18 +.
• Establishing care home block contracts to support discharge.
• Reduction in emergency admissions from care homes.
c) Intended Outcomes/Success Measures
This scheme will contribute to the following national BCF metrics:
• Admission avoidance metric: Reduction in non-elective admissions of people
with ambulatory care sensitive conditions. See scheme 1.
• Percentage of people who are discharged from acute hospital to their
usual place of residence: The percentage of Hillingdon residents aged 18 and
above discharged to their usual home. See scheme 3.
• Permanent admissions to care homes metric: See scheme 1.
The following measures will be used to identify whether the scheme is working:
• Number of CQC registered care providers that experience business failure.
• Number of CQC registered providers rated ‘good’ or above.
• Emergency admission from care homes rate per 1,000 65 and over population.
Page 23 of 35
Scheme 5: Integrated care and support for people with learning disabilities
and/or autism
a) Scheme Aims
The intended aims of this Scheme are to:
• 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) 2024/25 Priorities
The 2024/25 priorities under this scheme are:
• Continuing the development of crisis pathways for people with learning
disabilities and/or autistic people.
• Reviewing integration options for the LBH Learning Disabilities and CNWL
Learning Disabilities Health Teams.
• Completing the All-age autism strategy, 2024 - 2029.
c) Intended Outcomes/Success Measures
This scheme will impact on the following BCF metrics:
• Admission avoidance metric: See scheme 1.
• Percentage of people who are discharged from acute hospital to their
usual place of residence: See scheme 3.
The following measures will be used to identify whether the scheme is working:
• % of people with learning disabilities known to services in paid employment.
• % 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 24 of 35
Annex 2
SCHEDULE 1A - FINANCAL CONTRIBUTIONS SUMMARY AND BREAKDOWN
1. Figures in the tables within this Schedule are subject to rounding and therefore
totals given may not be the sum of the numbers provided.
FINANCIAL CONTRIBUTIONS SUMMARY
2. Table 1 summarises the total contribution by organisations in 2024/25.
Table 1: Financial Contributions by
Organisation 2024/25
Organisation 2024/25
NHS 29,851,857
LBH 70,173,307
TOTAL 100,025,164
3. Table 2 below provides a breakdown by BCF funding stream for 2024/25.
Table 2: Financial Contributions by Funding Stream 2023/24
FUNDING SOURCE
FUNDING
2024/25
Minimum NHS Contribution 24,164,009
Additional NHS Contribution 3,096,967
ICB Discharge Fund 2,590,881
NHS TOTAL 29,851,857
Minimum LBH Contribution 13,042,692
Additional LBH Contribution 55,385,658
LBH Discharge Fund 1,744,957
LBH TOTAL 70,173,307
TOTAL BCF VALUE 100,025,164
4. Table 3 below summarises the Council and NHS contributions for 2024/25.
Page 25 of 35
Table 3: ICB and LBH Financial Contribution by Scheme Summary
Scheme
2024/25
LBH
(£,000)
NHS
(£,000)
TOTAL
(£,000)
1. Neighourhood development 5,527 640 6,167
2. Supporting carers 671 308 979
3. Reactive care 6,267 22,240 28,507
4. Improving care market management and
development.
26,336 5,489 31,825
5. Integrated care and support for people with
learning disabilities and/or autistic people.
31,372 1,075 32,447
Programme Management 0 100 100
TOTAL 70,173 29,852 100,025
5. Annex A to this Schedule 1A of the Agreement summarises the funding to
be paid by the NHS to the Council for its retention.
ANNEX A: SUMMARY OF NHS FUNDING TO BE RETAINED BY THE COUNCIL
2024/25
Annex%20A%20Sch
edule%201A%20BCF
2024/25 FUNDING BREAKDOWN
6. Annex B to this Schedule 1A of the Agreement provides a detailed breakdown
of services, related funding and funding source reflected within the 2024/25
BCF plan.
ANNEX B: 2024/25 BCF SUBMISSION TEMPLATE EXPENDITURE TAB
Annex%20B%20Sche
dule%201A%20BCF%2
Page 26 of 35
Annex 3
SCHEDULE 1D: HOSPITAL DISCHARGE FUNDING ARRANGEMENTS
1. BACKGROUND AND OVERVIEW
1.1 The subject of this Schedule of the Agreement is the operation of hospital discharge
funding arrangements for 2024/25. The Schedule links into Scheme 3: Reactive care.
1.2 Unless the context otherwise requires, the defined terms used in this Schedule will have
the meanings set out in the Partnership Agreement.
2. FUNDING WITHIN THE POOLED BUDGET
Intermediate Tier Services: Step-down Nursing Care Home Beds
2.1 Table 1 below describes the annual funding breakdown from the 1st April 2024. The total
cost of block step-down provision in 2024/25 will be £1,014,000 as described in table 1.
The funding reflected in table 1 below will be contained within the Pooled Budget.
Table 1: Nursing Step-down Funding Breakdown 2024/25
NHS
Minimum to
ASC
NHS
Additional to
ASC
ICB
Discharge
Fund
LBH
Discharge
Fund
TOTAL
122,424 512,899 334,363 44,314 1,014,000
2.2 The Council has led a procurement process to identify suitable providers to deliver step-
down nursing bed provision. Contractual arrangements are summarised in table 2 below.
The need addressed from the provision shown in table 2 is general nursing, nursing
dementia and non-weight bearing (primarily Parkfield House).
Table 2: Step-down Nursing Beds Contractual Arrangements Summary
Setting Provider Bed
Number
Contract
Start
Date
Contract
End Date
Minimum
Annual
Cost
(£)
Minimum
Contractual
Period Cost
Parkfield
House
Canford
Healthcare
Ltd
10 01/04/24 31/03/27 676,000 2,028,000
Drayton
Village
GCH North
London Ltd
5 03/06/24 01/06/27 338,000 1,014,000
TOTAL 1,014,000 3,042,000
Page 27 of 35
2.3 Contracts with Providers contain a three (3) calendar month break clause that is operable
nine (9) months from commencement date. This means that the minimum duration of the
contracts will be one calendar year.
2.4 The management of inflationary uplifts will be as set out in the terms of the Council’s
standard contract, i.e., subject to the provider (s) evidencing increased costs.
Intermediate Tier Services: Other
2.5 Table 3 below provides a summary breakdown of other intermediate tier services in
2024/25. A full breakdown of services funded from the Discharge Fund in 2024/25 can be
found in Annex A to this Schedule.
Page 28 of 35
Table 3: Summary of Other Intermediate Tier Funded Services 2024/25
Service Provider Start
Date
End
Date
NHS
Contribution
(£,000s)
LBH
Contribution
(£,000s)
Total
Cost
2024/25
(£,000s)
A. Bridging Care Comfort Care
Services
01/04/24 31/03/25 641 0 641
B. Additional
Bridging Care
capacity
Comfort Care
Services
01/04/24 31/03/25 135.2 0 135.2
C. Additional
Brokerage
capacity
LBH 01/04/24 31/03/25 0 63.9 63.9
D. Social work
manager 7-day
capacity
LBH 01/04/24 31/03/25 0 57.6 57.6
E. Pathway 3
social work bed
manager
LBH 01/04/24 31/03/25 50 0 50
F. Reablement Comfort Care
Services
03/04/20 02/04/26 1,198 0 1,198
G. Deep clean &
house clearance
contract.
Telfords
Cleaners Ltd
01/04/24 31/03/26 0 8 8
H. Hospital
Discharge
AMHP
LBH 01/04/24 31/03/25 70.1 0 70.1
I. Mental Health
hospital
discharge social
worker
LBH 01/04/24 31/03/25 52.4 0 52.4
J. Mental Health
floating support
service
Ability
Housing and
Care
16/01/24 31/03/25 50.9 0 50.9
K. Complex P3
capacity
Independent
sector
933.4 0 933.4
L. Discharge-
related
residential care
home
placements
Independent
sector
03/04/23 31/03/2
View Decision / Minutes Text
Executive Decision Notice – 8 January 2025
This notice is a public document also available to view on the Council's website www.hillingdon.gov.uk
OFFICIAL EXECUTIVE DECISION NOTICE
PUBLISHED BY DEMOCRATIC SERVICES
Notice is hereby given that the following decision(s) have been made today by
Cabinet Members at the London Borough of Hillingdon:
Title of decision BETTER CARE FUND SECTION 75 AGREEMENT EXTENSION
Reference No. 1267
Date of decision Wednesday 8 January 2025
Call-in expiry date Wednesday 15 January 2025
Relevant Select
Committee
Health and Social Care Select Committee
Relevant Wards All
Decision made
Cabinet Members
making the decision
Cllr Ian Edwards, Leader of the Council
Cllr Jane Palmer, Cabinet Member for Health and Social Care
Decision Approved
That the Leader of the Council , in consultation with the
Cabinet Member for Health & Social Care:
1. Approved the extension to the 2023/24 Better Care
Fund agreement between the Council and the North
West London Integrated Care Board (NHS North West
London/ICB) under section 75 of the National Health
Service Act 2006 approved by Cabinet in November
2023 to cover the period from 1 st April 2024 to 31 st
March 2025 at a value of £100,025,164.
2. Approved the variation to the 2023/24 Better Care
Fund agreement between the Council and the North
West London Integrated Care Board under section 75
of the National Health Service Act, 2006, as described
in this report.
3. Delegated to the Corporate Director of Adult Social
Care and Health authority to amend the terms of the
agreement with NHS North West London during
2024/25, in consultation with the Leader of the
Council and the Cabinet Member for Health and
Social Care.
Reason for decision Extension of Section 75 agreement : At its meeting in
November 2023, Cabinet delegated authority to the Leader of
the Council with the Cabinet Member to extend the section 75
Executive Decision Notice – 8 January 2025
This notice is a public document also available to view on the Council's website www.hillingdon.gov.uk
(s75) agreement for 2024/25 and a one-year extension is
permitted under the 2023/24 agreement.
The Leader and Cabinet Member are advised that NHS England
makes the release of the £24,164k element of Hillingdon’s Better
Care Fund (BCF) that is under its control conditional on a pooled
budget being established between the Council and North West
London
Integrated Care Board (ICB) through an agreement
established under section 75 (s75) of the National Health
Service Act 2006 (NHS Act). This is in accordance with its
powers under the Health and Social Care Act 2012.
Local authorities and ICBs can enter into s75 agreements once
written notification has been received from NHS England that
plans have ‘assured’
status. Written confirmation of assured
status was received on 21st August 2024.
The Leader and Cabinet Member are being requested to
approve the recommendations in this report at such a late stage
in the year as a result of a timetable set by the Department of
Health and Social Care (DHSC). This is consequently not a
matter that the Council has any control over.
Variation to the 2023/24 BCF s75 agreement : The 2024/25
BCF is largely a roll forward of that for 2023/24 and therefore
much of the s75 remains the same; however, there are some
changes, and these are detailed in this report. Approval of the
recommendation will therefore ensure that the agreement
addresses the necessary changes for 2024/25, including
amendments to financial arrangements. The detail s of the
proposed changes to the agreement are set out in variation form
attached as Appendix 1.
Delegated authority to amend s75 agreement in -year: This
delegated authority recommendation will enable the Council and
ICB to respond quickly to any opportunities presented by
evolving national policy, such as additional funding.
Alternative options
considered and
rejected
Not extending the s75 agreement: The Leader and Cabinet
Member could decide not to extend the 2023/24 agreement to
cover 2024/25 BCF plan arrangements. This is not
recommended as it would impact on the availability of £24,869k
in 2024/25 NHS funding to support the local health and care
system, including £8,812k to protect adult social care. It could
also impact on the £5,575k Disabled Facilities Grant (DFG) that
is paid directly to the Council by the Ministry
of Housing,
Communities and Local Government ( MHCLG) and also the
£7,468k Improved Better Care Fund Grant (iBCF) that is also
paid directly to the Council by MHCLG. In each case, grant
conditions require that the Council has an agreed BCF plan in
Executive Decision Notice – 8 January 2025
This notice is a public document also available to view on the Council's website www.hillingdon.gov.uk
place that meets national conditions, one of which is having a
s75 agreement in place.
Not delegate authority to amend s75 agreement in-year: The
Leader and Cabinet Member could decide not to approve
delegation arrangements or to add some additional
requirements. This option is not recommended as the
recommendation is intended to create agility within the health
and care system to respond to evolving circumstances,
including new funding opportunities.
Classification Part I - Public
Link to associated
report
Here
Relevant Officer
contact & Directorate
Gary Collier – Adult Social Care and Health
Any interest declared
by the Cabinet
Member(s) /
dispensation granted
N/A
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officers?
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from the expiry of the scrutiny call-in period which is:
5pm on Wednesday 15 January 2025
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valid call-in request, Democratic Services will immediately advise
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Local Authorities (Executive Arrangements) (Meetings and Access
to Information) (England) Regulations 2012.
This is the formal notice by the Council of the above executive
decision, including links to the reports where applicable.
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