health and wellbeing board - Committee Management ...

REFERENCE:

HWB/09/19

NOTICE OF MEETING Date : THURSDAY, 19 SEPTEMBER 2019

Time : 18:00

Place : COMMITTEE ROOM 3 TOWN HALL, LUTON, LU1 2BQ

MEMBERS:

Councillor Simmons Leader (Chair)

Councillor Campbell Minority Group Representative, Luton Council

Councillor J. Hussain Portfolio Holder, People (Adults)

Councillor M. Hussain Portfolio Holder, People (Children)

Councillor Hopkins Portfolio Holder, Commissioning and Public Health

Dr Chirag Bakhai (Clinical Director for Planned Care, Luton CCG)

Michelle Bradley (Director of Beds and Luton Mental Health and Wellbeing Services, ELFT)

Georgie Brown (NHS England)

David Carter (CEO, L&D Hospital)

Laura Church (Chair, Community Safety Executive)

Supt. Greg Horsford (Beds Police)

Amanda Lewis (Director of People, Luton Council)

Lucy Nicholson (CEO Healthwatch Luton)

Maud O,Leary (Service Director, Adult Social Care)

Dr Nina Pearson (Chair - Luton CCG)

Anita Pisani (Deputy CEO, CCS)

Nicky Poulain (Chief Operating Officer, Luton CCG)

Robin Porter (Chief Executive, Luton Council)

Gerry Taylor (Director of Public Health, Commissioning and Procurement, Luton Council)

Philip Turner (Chair Healthwatch Luton)

Quorum: 7 of the members listed above, in person.

Contact Officer: Bert Siong (01582 546781)

Purpose: This Board provides the leadership for and oversight of the development of wider health and social care partnership arrangements, operating within the statutory framework established under the Health and Social Care Act 2012. It is locally accountable for improving the health and wellbeing of the population of Luton, through integration and joint working/ commissioning of services across the NHS, Social Care and Public Health.

Public Information: This meeting is open to the public, who are welcome to attend. Members of the public are entitled to take photographs, film, audio-record and report on all public meetings in accordance with the Openness of Local Government Bodies Regulations 2014. People may not however act in any way considered to be disruptive and may be asked to leave. Notice will be given verbally at the meeting.

HEALTH AND WELLBEING BOARD

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EMERGENCY EVACUATION PROCEDURE Committee Rooms 1, 2, 4 & Council Chamber:

Turn left, follow the green emergency exit signs to the main town hall entrance and proceed to the assembly point at St George's Square.

Committee Room 3:

Proceed straight ahead through the double doors, follow the green emergency exit signs to the main Town Hall entrance and proceed to the assembly point at St George's Square.

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AGENDA Agenda Subject Page Item No.

INTRODUCTIONS

1 APOLOGIES FOR ABSENCE

2 MINUTES

1. Minutes 16th July 2019

5 - 15

3 DISCLOSURES OF INTEREST

Members are reminded that they must disclose both the existence and nature of any disclosable pecuniary interest and any personal interest that they have in any matter to be considered at the meeting unless the interest is a sensitive interest in which event they need not disclose the nature of the interest.

A member with a disclosable pecuniary interest must not further participate in any discussion of, vote on, or take any executive steps in relation to the item of business.

A member with a personal interest, which a member of the public with knowledge of the relevant facts would reasonably regard as so significant that it is likely to prejudice the member’s judgment of the public interest, must similarly not participate in any discussion of, vote on, or take any executive steps in relation to the item of business.

Disclosable pecuniary interests and Personal Interests are defined in the Council’s Code of Conduct for Members and Co-opted members.

4 URGENT BUSINESS The Chair to report on any business which is considered to be urgent and which should be discussed at the meeting in accordance with Section 100B(4)(b) of the Local Government Act 1972 and to determine when, during the meeting, any such business should be discussed.

5 REFERENCES FROM COMMITTEES AND OTHER BODIES

REPORTS

6 Luton’s Health And Wellbeing Strategy (Report of the Corporate Director, Public Health and Wellbeing)

16 - 26

7 Luton Better Care Fund Template 2019-2020 (Report of the Corporate Director, Public Health and Wellbeing)

27 - 122

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8 Luton’s Response to Advancing Our Health - Prevention in the 2020s (Report of the Corporate Director, Public Health and Wellbeing)

123 - 206

9 Update Report from Luton Transformation Board (Report of the Chief Operating Officer, Luton CCG)

207 - 225

10 Integrated Strategy for People with Learning Disabilities in Luton (Report of the Chief Operating Officer, Luton CCG)

226 - 234

11 Health Inequalities Delivery Board (Report of the Corporate Director, Public Health and Wellbeing)

235 - 237

INFORMATION ITEMS

12 Healthwatch Luton Quarterly Update – Reference Only (Report of the Chief Executive, Healthwatch Luton)

238 - 244

13 HEALTH AND WELLBEING BOARD WORK PROGRAMME REPORT 2019 (Report of the Senior Public Health Manager)

245 - 252

14 LOCAL GOVERNMENT ACT 1972, PART VA To consider whether to pass a resolution under Section 100A(4) of the Local Government Act 1972 to exclude the public from the meeting during consideration of any item listed above if it is likely that if members of the public were present during those items there would be disclosure to them of exempt information falling within the Paragraphs of Part 1 of Schedule 12A to the Local Government Act 1972.

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MINUTES OF THE HEALTH AND WELLBEING BOARD

16TH JULY 2019 AT 6.00 PM

MEMBERS PRESENT:

Councillor Simmons Leader (Chair) Councillor Campbell Minority Group Representative, Luton Council Councillor J. Hussain Portfolio Holder, People (Adults) Councillor Hopkins Portfolio Holder, Commissioning and Public Health Dr Chirag Bakhai (Clinical Director for Planned Care, Luton CCG)

Michelle Bradley (Director of Beds and Luton Mental Health and Wellbeing Services, ELFT)

Amanda Lewis (Director of People, Luton Council) Lucy Nicholson (CEO Healthwatch Luton) Dr Nina Pearson (Chair - Luton CCG) Anita Pisani (Deputy CEO, CCS) Nicky Poulain (Chief Operating Officer, Luton CCG) Robin Porter (Chief Executive, Luton Council)

Gerry Taylor (Director of Public Health, Commissioning and Procurement, Luton Council)

Philip Turner (Chair Healthwatch Luton)

NAMED SUBSTITUTES MEMBERS: OBSERVERS:

Councillor Agbley Chair-Scrutiny Health and Social Care Review Group IN ATTENDANCE/ ADVISORS:

Stephen Gunther Service Director, Healthcare and Adults Commissioning, Luton Council

INTRODUCTIONS

Councillor Simmons led the introductions and welcomed all Members, Partners and Officers present.

AGENDA ITEM

2.1

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16 APPOINTMENT OF VICE CHAIR – LUTON CCG (REF: 1)

Resolved: That the Dr. Nina Pearson, Chair of the Luton Clinical Commissioning Group be appointed Vice Chair of Health and Wellbeing Board for the ensuing municipal year 2019/20.

17 APOLOGIES FOR ABSENCE (REF: 2)

Resolved: Apologies for absence from the meeting were received from Councillor M. Hussain and Maud O’Leary Service Director Adult Social Services.

18 MINUTES (REF: 3)

Resolved: That the minutes of the meeting held on 13th March 2019 be taken as read, approved as a correct record and the Chair be authorised to sign them.

19 LUTON’S HEALTH AND WELLBEING STRATEGY DEVELOPMENT ACTION PLAN (REF: 7)

The Service Director Healthcare and Adults Commissioning delivered a Power

Point presentation entitled Health and Wellbeing Strategy Development. He explained the context of the presentation and stated that this was a reflection of progress of work since 2012, and an understanding of the current health and wellbeing challenges. He said it was time to shape and develop the board’s approach and set priorities and determine how success could be measured.

The Service Director explained that the Health and Wellbeing Boards were

established to create and improve the key health and wellbeing issues in specific areas and particularly look at issues which could be resolved by partners working together for a common purpose.

He said that the 2012 strategy had three main priorities, namely:

1. Every child and young person had a healthy start in life 2. Reduce health inequalities in Luton 3. Healthier and more independent adults and older people

He explained that one of the key drivers of infant mortality was poverty but a slight

improvement had been recorded over the past few years and a lot remained still to be done. He highlighted the key outcomes namely:

• Reduced the infant mortality rate • Increased life expectancy and narrowed the inequality gap compared with

the rest of England • Narrowed gap in life expectancy between the most and least deprived areas

in Luton • Increased disability free life expectancy at age 65.

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In terms of the refresh health and wellbeing board strategy for 2016/19, the main focus was on homelessness and housing with progress measured through 11 outcomes including family homelessness rate per 1,000 households, excess winter deaths index, proportion of older people over 65s and emergency hospital admissions due to falls in this age group. Some progress had been recorded in terms of winter access and learning disabilities in settled accommodations.

Members were further informed of recent changes including Public Health (PH)

Peer review, NHS Long-term plan with wider NHS changes and place based prioritisation response, refreshed Joint Strategic Needs Assessment (JSNA) prioritisation process and new Luton council focus on eradicating poverty planned delivery through Luton 2040.

One of the key recommendations of the PH Peer review was for Luton to become a

public health town. Other recommendations include: • Use of refresh of the Luton investment Framework (LiF) to have one vision and

ambition for Luton developed and over by partners, stakeholders, and the community.

• Outcome based, clear delivery, refreshed governance and ongoing evaluation. • Need for the HWB to decide how it could become more inclusive of

neighbourhood, place and system level. • Need for the HWB to consider how it could improve current population health

management capability that would enable data driven planning, and insight and analysis.

• Need for the HWB to consider how it could achieve its ambition for the residents and to address health inequalities to increase pace, particularly given the fast moving transient nature of Luton’s population.

Gaps exist between the NHS Long-Term Plan aspiration and current services such

as; • Cancer, especially early identification and prevention, • Children and young people, especially Learning Disability (LD), and autism and

mental health, adult mental health • Adult Mental Health – early support and 24/7 crises care In relation to core key areas, members of the HWB should consider the level of

engagement it wishes to partake in, bearing in mind that there could be a further Government regeneration plans, etc. There were other key areas coming out of adults such as social isolation and physical health of adults, etc.

The Director of Public Commissioning and Procurement Luton Council explained

that this was more of a summary of proposed actions to identify the board’s priorities. She stated that some of these issues had been discussed and agreed at several partnership and council meetings and invited members to make comments to inform the proposals.

The Chair of the Luton CCG commented on the demographics and mobility of the

population and asked if new residents have an impact on the board’s priorities and how it would provide support to the new arrivals in Luton. How would the HWB factor in the mobility aspect into its priorities?

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In response, the Director of Public Commissioning and Procurement stated that issues which have impact on the priorities of the HWB would be factored into the proposals. She stated that there was need to think about how the Board would deliver its cross cutting priorities. One of the outcomes of the Peer review was that Luton was fairly unique and the task for the HWB would include mobilising inclusive growth and to encourage people to stay in the town, it’s about encouraging place based.

Members of the Board agreed the approach and the priority areas of focus with

some amendments. The Luton 2019 Draft Strategic Priorities Summary for Consultation were presented

for comments from members of the Board. The strategic priorities for consultation where highlighted in sub headings;

Place • Focus on family prosperity • Meeting Housing Need and ensuring that people of Luton lived in safe and

suitable homes • Inclusive Growth • Creating Healthy environment People and Best Start • Improve mental health and wellbeing of children • Needs of children with special needs • Increase in employment, education and training opportunities for children and

young people • Increase in school attendance • Increase in the number of children that were of healthy weight • Ensuring healthy start to life for children and young people Adult Wellbeing • Increase the number of adults with healthy weight, nutrition and physical activity • Improve mental health and wellbeing for adults • Decrease drug and alcohol related hard in adults Ageing Well • Increase in social connections • Improving Physical Health in Older People The Chair of the HWB commented about the challenges around dental matters in

Luton and stated that it be included in the priorities to link in with the Joint Strategic Needs Assessment (JSNA).

The Director of People stated that the approach for the strategic priorities should

include 19-25 years young people who were considered to be at risk of serious youth violence. She said this area was less explicit in the report and should be seen as a priority to ensure safeguarding for children and young people. She asked what the Board’s level of ambition would be around school attainment and whether there was need to word it slightly different.

The Clinical Director for Planned Care Luton CCG commended that there was need

to support people in terms of engagement and inclusiveness and to encourage them to take actions themselves to improve their own health.

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The approach for the Luton 2019 draft strategic priorities summary areas was supported by the HWB subject to inclusion of areas in relation to self-help health, serious youth violence and school attendance.

Recent Evidence Review This required a common and clear purpose including clarity around governance

arrangements to manage decisions, risk and failure and the need to continue to review and refine place based outcomes and performance framework. There was also the need to develop longer finance and a broader ambition for plan by 2040 to shift resources from acute provision to community social and primary care as a proportion of total funding monitored through the place based outcomes and performance framework. In terms of delivering this, four pillar approach had been proposed namely:

• The wider determinants of health • An integrated health and care system • Our health behaviour and lifestyles • The places and communities we live in and with. In terms of approach for the proposed priorities, members were asked to consider

and comment on the caption “enabling the people of Luton to thrive where everyone in Luton will have the opportunity to live a life in which they are mentally and physically healthy, their potential is maximised and inequalities are reduced”. This was an attempt to capture key elements in terms of the approach. Members were asked if they agreed with the approach.

The Director of People suggested that in terms of enabling, the HWB should move

from the enabling to keep the essence of what was been articulated. She also suggested that the later part of the phrase should be more inclusive.

There was also suggestion about the need to capture plans to eradicate poverty. Another member stated that the key work in the phrase was “thrive”. The Director of Public Health, Commissioning and Procurement welcomed the

comments and stated that officers would work with the comments received and progress would be reported at a future meeting of the HWB.

The approach for the Board to take This was about changing the narratives and engaging more robustly to ensure that

everyone was involved in matters that concerns them. The Service Director Healthcare and Adult Commissioning asked members of the Board to comment on the direction of travel in terms of the approach and delivery where there was need to strike a deal with the citizens to ensure that both the Board and the citizens have a role to play.

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He explained Wigan’s example of the changing governance model which focuses on areas D-E. Members commented that unless a whole town approach was adopted no impact would be made, however, there was need to identify how the conversation would be enabled. The general steer of the Board was to move towards D and E so as to have a plan that would become everybody’s business and should be done in a consistent manner.

Proposed Life –course approach There was need to have the commitment as an employer to go the extra mile and

ensure that a good foundation for a healthy life was well developed to ensure that people develop the opportunity to live a health life and age well.

In terms of skills and learning, there was need to have sufficient focus on primary

age and there might be need to strengthen the gap between children and young people. It might be necessary also to increase the Board’s aspiration to ensure that the proposals work well. There should also be focus on messaging the ambition around supporting children and young people.

In terms of starting and developing well, this was an ambition, how much should be

included and should the Board focus on ageing in the HWB priority. The Health and Wellbeing Strategy was part of the delivery of key strategic priorities.

Members agreed the general concept and approach that everyone in Luton should

have the level of meaningful social contact and lives the end of their life with dignity in the place of their choice.

In terms of the main outcome measures, the key areas should focus on mortality

rate and preventable hospitalisations, mental health services and preventative health and social care. There was need for improvement and for continuous review to be iterated.

In relation to the proposed approach the focus should include, use of data and intelligence, quantify the burden at pollution level and identifies inequalities and risks, seek evidence of effectiveness to improve the problem, work with communities, etc.

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Regarding implementation this was the time to progress the plans and proposals.

The support and development requirements needed to enable effective implementations and what sort of direction was required from the Board, steer and or immediate suggestions.

The next steps were highlighted: • Collate feedback and draft the HWBS • Engage with wider interest parties – review and refine where appropriate • Develop support programme for implementation and • Draft for sign off at next HWBB.

Members agreed that clear communication plan was essential to the strategy and

therefore would like to see clear actions in terms of how communication could be improved to reach out to citizens.

The Chief Executive stated that the strategy was currently in draft form and that it

was important to have a clear and accurate process. The process would include substantial exercise of reaching out to the public, including public and private sectors.

The issue of how to inform people without raising expectation was raised. The Chair of Luton CCG commented about the need to engage and to celebrate

success in the process. She said the still birth rate in Luton had dropped considerably when compared to national target and therefor Luton’s achievement should be celebrated whilst ensuring an effective HWB strategy.

The Director of Public Health, Commissioning and Procurement explained that in

relation to the proposed approach, we can take a more asset based approach to build on success. Matters relating to communication and consultation with partners, the draft strategy would be presented to the Scrutiny Health and Social Care Review Group as part of the consultation and engagement of the proposals. There would be need to develop the plans and to describe the Board’s approach to work with people and to also identify the next steps in terms of delivery.

Another member stated that the strategy could be shaped in terms expectation and

actions to ensure that everyone could thrive. There should be a snappy message in the way members plan to engage to understand the priorities.

It was also suggested that the strategy should also be submitted to the next Health

and Social Care Engagement Group meeting. The Service Director Healthcare and Adults Commissioning commented that the

engagement and communication plans had improved in terms of development of the JSNA and wider community stake holders. It had shifted positively in the last couple of years.

Resolved: (i) That the contents of the presentation and emerging priorities from the

Joint Strategic Needs Assessment (JSNA), NHS Long-term plan place based response and recommendations from the Public Health (PH) Peer review in respect of the priorities for a new Health and Wellbeing Strategy be noted.

(ii) That the approach and proposals of the Luton’s Health and Wellbeing Strategy

Development and Action Plan be supported subject to comments and suggestions from the HWB.

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HEALTHWATCH LUTON ANNUAL REPORT 2018 – UPDATE AND OVERVIEW (REF: 8)

The Chief Executive Luton Healthwatch presented the quarterly activities of the

organisation. She stated that the Healthwatch network had been funded by NHS England to carry out engagement with communities across the country to establish how the Long Term Plan (LTP) should be implemented at a local level.

It was intended that the views gathered would feed into the development of the

NHS’ local plans. Prior to the start of this project, local HW met with ICS colleagues to outline the

engagement programme and to determine their priorities. Following discussions, it was agreed that in addition to seeking public views on general health and care services, local HW would also conduct focused engagement on cancer and mental health services as these had been identified as priority areas for BLMK ICS.

She advised that the full report had been submitted to BLMK ICS and had been split

into two reports; one at scale and one at local level. The full report would be published on 17th July 2019.

She highlighted the keys points of the engagement as follows; • Access and Jointed up approach and improved communication • In Luton, most people were generally happy with the care received but had

issues with access to service. • Communication awareness It was expected that the key points would feed into the Luton Plan to try and engage

more in communications and GP access. A member of the Board commented that there had always been an issue in regards

to GP access and what was sufficient for local people. There were pressures to meet the needs of people in a timely manner.

There were other options available to service users who require urgent GP access,

the111 service. HW commented that this was one of the well-known but highlighted issues from the report, that people in Luton were struggling to access GP’s – resulting in more people using A&E.

A Member of the Board from rom Luton CCG commented that it was important to

ensure that GP practices should not be operating closed GP list. The Vice Chair of the Board stated that the CCG should be informed of GPs practices in Luton who were operating closed list.

The Chief Executive, Luton Healthwatch stated that where people were unable to

get urgent appointment with their GPs first thing in the morning they turn up at the hospital and just compounds the waiting list and urgent care provided at hospital.

Resolved: That the Healthwatch Luton Annual Report (Ref: 8) progress update, overview of its activities be noted.

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12 PROSPERITY THROUGH PROCUREMENT A FIVE YEAR STRATEGY (REF: 9) Members of the Board received the report (Ref: 12) on the “Prosperity Through

Procurement”. The report informed the Board about the draft procurement strategy and its links and proposed contributions towards addressing health inequalities and the need to explore various opportunities for increased collaboration to achieve its identified outcomes.

The Council’s current procurement strategy was due for review in June 2019 and

the ‘Prosperity Through Procurement’ was under consultation as the new procurement strategy for the Council. Child poverty had increased with an estimated 28,400 children (46%) living in poverty and projections showed that child poverty would increase highly within the next five years. The strategy could be a significant challenge for Luton therefore, it should be focussed on local issues in terms of addressing and tackling poverty as a priority which would link unemployment and local economy.

Members of the Board welcomed the proposals. A member asked what would be the marker that the strategy was effective and

whether the timeframe was realistic. In response, members were advised that very earlier on, on the journey it was identified that the 1st year would be spent to pull data together and to identify concreate ways of measuring social outcomes and systematic way of measuring values.

Commenting on the report and its proposals, the Chief Executive of Luton Council

explained that this was a process that would effectively tackle policy and absolutely hit a number Luton’s agenda in terms of town centre, community cohesion, etc. It would be one of the starting points to address poverty in the town and would then be presented to the Executive with a desire to adopt the strategy.

A member of the Board stated that there was need to encourage Suppliers to pay

the living wage and asked what the longer term strategy was. Officers advised that the ‘Prosperity Through Procurement’ strategy would focus on two key areas namely:

• Harnessing the collective power of the local public sector ‘anchor institutions’ to

work together to maximise wider economic benefits to the local community; and • Making a range of internal changes to the way the Council procures good and

services It was stated that the Luton Inclusive Growth Commission, established in 2018, had

the key aims of improving skills and productivity, raising aspirations, attracting more quality jobs, supporting communities to be healthier, ensuring equality as well as encouraging people to remain and spend their money in the town. The way in which the Council uses its spending leverage through procurement could significantly help deliver these aims and aspirations and act as a foundation for building local wealth. The estimate of the overall public sector spend in Luton was said to be around £800m; increasing the proportion of this expenditure locally, supporting local people in employment, would have a significant impact on local economy and the quality of life of local residents.

The November 2019 deadline, was expected to trigger dialogue and there was

need to be mindful of the financial challenge over the next four years. In terms of consultation, dialogue was currently taken place within the Council,

including Departmental Management Teams and the Corporate Leadership Management Team. In addition the Bedfordshire Chamber of Commerce and Federation of Small Businesses were also being consulted.

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The Director of People welcomed the proposals and stated that it was an added

value to the Council and the community in general, she stated however, that the Service should endeavour to be more inclusive and to extend the ambition to highlight the interest of young people. She said that giving the value of the proposals, it would be interesting to see what approach would be taken by the Council’s partners in terms of adopting and implementing the strategy including sign up and commitment.

In terms of general practice and consumables, partners would require time to

establish themselves and to have good understanding of the strategy likewise in terms of recruitment there was need to think about the way forward and how this could be adopted within.

In terms of direction of travel, the Service would work with partners and the

Council’s Suppliers across the town. This was the right time to think about the involvement of the Health and Wellbeing Board and what it could contribute to the proposals and implementation of the strategy.

Members were informed that a range of actions arising from the strategy were set

out within the report and including a range of changes and improvements to internal procurement processes, proposals for greater collaboration with the public and the development of a new social value framework.

The Joint Strategic Needs Assessment 2012/19 sets out strategic

recommendations in four areas listed below which link in with the draft strategy.

• Healthy Place • Healthy Start • Adult Wellbeing • Ageing well

Resolved: (i) That the draft procurement strategy ‘Prosperity Through

Procurement’ be received, noted and supported by the Health and Wellbeing Board. (ii) That the Service Director, Quality and Corporate Procurement Public Health,

Commissioning and Procurement be requested to consider the inclusion of “Children in Care or Looked After Children” (LAC) as part of the final Strategy.

INFORMATION ITEMS ONLY

13 UPDATE ON THE IMPACT OF UNIVERSAL CREDIT (REF: 10) Resolved: Noted.

14 MINUTES OF HEALTH AND SOCIAL CARE ENGAGEMENT GROUP MEETING – 26TH MARCH 2019 (REF: 11)

Resolved: Noted.

15 LUTON SAFE GUARDING CHILDREN BOARD ANNUAL REPORT (REF: 12) Resolved: Noted.

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16 DRAFT WORK PROGRAMME REPORT 2019-20 (REF: 13)

The Board received the work programme and resolved as set out below. Resolved: That the Democracy and Scrutiny Officer be delegated the responsibility

to update the work programme, following consultation with the Chair, and Public Health in line with the addition of items agreed by the Board, as follows:

• Progress on Proposed Development – September meeting • Procurement Standards – September meeting • Luton’s Health and Wellbeing Strategy Development and Action Plan.

(Note: The meeting ended at 19.50)

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AGENDA ITEM 6

DATE OF MEETING: 19TH SEPTEMBER 2019 REPORT OF: THE CORPORATE DIRECTOR, PUBLIC HEALTH AND WELLBEING REPORT AUTHOR: YACCUB ENUM, SENIOR PUBLIC HEALTH MANAGER SUBJECT: LUTON’S HEALTH AND WELLBEING STRATEGY

WARD(S) AFFECTED: ALL PURPOSE

1. For the Board to comment on the first draft of the joint Health and Wellbeing Strategy following initial discussions at the July Board.

RECOMMENDATION(S)

2. To note the contents and comment on the first draft joint Health and Wellbeing Strategy and proposed governance arrangements.

3. To agree to have the final version at the next meeting for sign off.

4. To agree to have a Board development session at a future Board meeting.

BACKGROUND

5. At the meeting in July 2019, the Board discussed the prioritisation of action and outcomes for the Health and Wellbeing Strategy and requested a draft report for discussion at the next meeting (September 2019).

6. The draft report is attached as appendix 1

REPORT

7. The report sets out our ambition - Luton is a more equitable place where we enable people to thrive, to have the opportunity to live a healthy life mentally, socially and physically; and maximize their potential.

8. It then outlines out our broad approach, which is to take action on the wide range of factors that affect people’s health in three stages:

a. Starting & Developing Well – where we lay the foundations for a healthy life,

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b. Living & Working Well – where we ensure people have the opportunity to

live a healthy life in a healthy environment and have access to good employment

c. Ageing & Dying Well – where we capitalise on the work done above to live a healthy old age.

9. Our goals, action and outcomes are underpinned by these themes

IMPLICATIONS

10. The strategy will drive our work to improve the health and wellbeing of Lutonians. CONSULTATIONS

11. In addition to the consultation carried out as part of identifying the priorities, the draft strategy was presented to the following groups for comment; and feedback incorporated

a. 30th July Luton and Health and Social Reference Group b. 2nd September – Public Health & Wellbeing DMT c. 9th September - Place Based Management Team

APPENDICES

12. Appendix 1 – Luton’s joint Population wellbeing Strategy 2019-2024

LIST OF BACKGROUND PAPERS LOCAL GOVERNMENT ACT 1972, SECTION 100D None

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APPENDIX 1

Luton’s joint Population wellbeing Strategy 2019-2024

Our ambition: Luton is a more equitable place where people thrive, have the opportunity to live a

healthy life mentally, socially and physically; and maximize their potential.

Foreword Health and Wellbeing Boards were created to improve the key health and wellbeing issues in an area: those issues that can only be resolved by partners working together to a common goal. This strategy is part of a wider programme of action we are taking to eradicate poverty, Luton 2040 (A growing town built on fairness: A town of hope and aspiration, where everyone can share in its success). By working together to build trust and gain a common purpose to deliver our first strategy published in 2012, the partners on Luton’s Health and Wellbeing Board have made a real impact on the lives of some of our more vulnerable citizens in our town. We will continue to strive to improve the health and wellbeing of Lutonians. Over the next five years we can make some real changes that will enable people to reach their full potential. Real success will come from us working with Luton’s community, building on all our strengths to maximise the solid foundations we have already built to enable the people of Luton to thrive. Hazel Simmons Chair of the Health and Wellbeing Board, Leader of Luton Borough Council Nina Pearson Vice Chair of the Health and Wellbeing Board Chair Luton Clinical Commissioning Group

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Background Much has changed since the Health and Wellbeing Board set out its initial strategy in 2012 and refreshed it in 2016. We have seen reductions in infant deaths, improvements in life expectancy and a reduction in the gap between the richest and poorest communities within the borough as well as reductions in homelessness. However, this progress in life expectancy has stalled in the last couple of years, as nationally and therefore there is still more we wish to do together. This strategy is our on-going commitment to come together to agree and work for the future we want for Luton and a starting point from which we will develop ever-stronger future versions. We will look to refresh our ambitions periodically with the aim of Eradicating poverty in Luton by 2040. Throughout 2019 we have been discussing and agreeing where the areas of focus should be to achieve this aim. We have updated our membership to ensure we have the right voices around the table and agreed on where we should put our collective energies so that everyone in Luton will have the opportunity to live a life where they are mentally, socially and physically healthy; where there is equity and everyone can maximise their potential. This is in the context of the Council setting out its long-term plan for the town (Luton 2040 – to eradicate poverty by 2040). This strategy’s parallel strategy, Inclusive Economy, sets out local priorities for us to deliver on. Delivery strategies will include Luton’s response to the NHS Long-term plan, as part of a wider partnership across Beds, Luton and Milton Keynes. These actions collectively will enable us to continue to drive improvements in health and wellbeing for the people of Luton. Our Ambition

Luton is a more equitable place where people thrive, have the opportunity to live a healthy life mentally, socially and physically; and maximize their potential.

What approach will we take? We know poor health can be experienced throughout life and the circumstances in which people are born, grow, live, work and age will have an impact on people’s wellbeing. If we do not try to positively promote wellbeing from birth (if not pre-birth), we will always be managing or seeking to ameliorate poor health. From this point of view, a preventative approach from the beginning of life to death, considering the wide range of factors that influence health, is our keystone. We will do this by approaching a healthy life in three stages, taking action on the wider factors that affect people’s health.

1) Starting & Developing Well – where we lay the foundations for a healthy life, 2) Living & Working Well – where we ensure people have the opportunity to live a healthy life in a

healthy environment and have access to good employment 3) Ageing & Dying Well – where we capitalise on the work done above to live a healthy old age.

Therefore, our action and outcomes will be under these three main themes. This Strategy sets out the Board’s view of the critical foundations on which a healthier population, living longer lives in healthy environments, free from health inequalities will be based. Our goals are that;

1. Every child in Luton achieves the level of development needed in their early years to provide the foundation for a healthy life

2. Every child is healthy, including having a healthy weight and good oral health 3. Every child and young person has access to a good education support when needed 4. Every young person in Luton is safe, skilled and equipped to be successful throughout

their life 5. Every adult in Luton is physically and mentally healthy and able to thrive 6. Every adult in Luton has access to training to develop skills and access to good

employment required to drive our commitment to eradicate poverty 7. Everyone in Luton lives in good quality housing, has access to green space and good air

quality 8. Everyone in Luton has the level of meaningful social contact that they want

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https://www.luton.gov.uk/Health_and_social_care/Lists/LutonDocuments/PDF/Health/NHSStrategyPoster2013LR.PDF

https://www.luton.gov.uk/Health_and_social_care/Lists/LutonDocuments/PDF/Health%20and%20wellbeing%20strategy.pdf

https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/the-nhs-long-term-plan-summary.pdf

https://www.blmkpartnership.co.uk/

9. Everyone in Luton lives the end of their life with dignity in the place of their choice

Our Inclusive Economy work aims to make improvements to the social and economic factors that impact on people’s wellbeing (i.e. better incomes, improved skills, regenerated town and neighbourhood areas, opportunities for participation in culture) and acts in conjunction with the Health and Wellbeing Board to achieve our Luton 2040 ambition. How will we know we are successful? The overall success of the strategy will be measured through improvements in a number of overarching outcomes as set out below from a baseline of 2019 to 2024 (APPENDIX C). These outcome measures, which have been developed as part of our population health indicators, will be reviewed and updated as required. Specific improvements in these indicators will be developed by the Delivery Boards and agreed with the Health and Wellbeing Board. Delivery Boards will give bi-annual updates on progress. Healthy life expectancy is the best overall measure of both health and health inequalities, representing the number of years someone can expect to live in good health. In Luton, the gap between the best and worst off is 13 years for males and 15 years for females. This is similar to our statistical neighbours. Our goal therefore is primarily to close the gap in healthy life expectancy in Luton by improving the health and wellbeing of the poorest and most vulnerable the fastest. Implementation The Board will continue to provide direction and vision, acting as a guiding partnership, offering partners the opportunity for shared decision-making to deliver shared outcomes. The general principles in which the Board will work are;

• This is a collective effort and we will not be constrained by professional or organisational boundaries

• We will set our ambitions with stakeholders and residents, working with and for communities • We will learn from the best and adapt to local circumstances • Our work will be led by data, evidence and local intelligence taking in the whole picture • Our efforts will focus on what is effective to solve problems and deliver outcomes • We will generate both long-term and short-term solutions and be honest about what happens

first. The Board will provide effective governance to ensure delivery of our ambitions and continue to ensure we have the right focus for the town, which we all agree to concentrate on and contribute to. It will be a place to enable partners to engage in a meaningful way with the town’s future and a way of sequencing a range of activity as a town so that the early deliverables make longer-term goals possible to achieve. The Board will critique annual reviews of our delivery plans to ensure the priorities (Appendix A) remain relevant and outcomes are being achieved. To enable and support implementation of these plans, the Board will implement a support programme of training and development, not just for officers but more importantly to supporting local community champions who support residents. The Board will work in conjunction with the “Inclusive Economy” Board (to be developed) to drive action towards Luton 2040 ambition, acknowledging and sharing progress in the two Boards’ shared interests to ensure action is maximised. These two boards with shared interests (Figure 2) will be part of the overall governance for delivery (see Appendix B) of the Luton 2040 ambition. The Health Inequalities Board will provide challenge and support to both the Health and Wellbeing Board and Inclusive Economy Board to ensure that the actions taken are improving the health and wellbeing of the poorest the fastest.

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Figure 1. DRAFT Delivery model

Figure 2: DRAFT parallel work streams outlining shared interests

Shared leadership

Effective goverance

Evidence led preventative

action

Co-produced action with

our community

Evaluated outcomes

People & Place strategies

Eradicating poverty by 2040

Ambition

A growing town built on fairness: A town of hope and aspiration, where everyone can share in its

success

Outcome

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Appendix A. Luton’s strategic Priorities

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Appendix B. Governance structure

Health & Wellbeing Board

Children's Trust Board

Health Inequalities Delivery Board

Transformation Board

Health Protection Board

Inclusive Economy Board

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Appendix C. Outcome measures Ambition Outcome measures Overall ambition: Luton is a more equitable place where people thrive, have the opportunity to live a healthy life mentally, socially and physically; and maximize their potential.

• Healthy life expectancy at birth (Male) • Healthy life expectancy at birth (Female) • Life expectancy at birth (Male) • Life expectancy at birth (Female) • Inequality in healthy life expectancy at birth within LA

(Male) • Inequality in healthy life expectancy at birth within LA

(Female) Our Goals

Goal 1: Every child in Luton achieves the level of development needed in its early years to provide the foundation for a healthy life

• School Readiness: the percentage of children achieving a good level of development at the end of reception

• School Readiness: the percentage of Year 1 pupils achieving the expected level in the phonics screening check

• Pupil absence • Percentage of children achieving at least an expected level

of development across all learning goals in communication and language

• Percentage of children where there is a cause for concern • Child poverty

Goal 2: Every child is healthy, including having a healthy weight and good oral health

• Reception: Prevalence of overweight (including obesity) • Year 6: Prevalence of overweight (including obesity) • Proportion of five year old children free from dental decay • Children with one or more decayed, missing or filled teeth

Goal 3: Every child and young person has access to a good education support when needed

• Homeless young people aged 16-24 • Average Attainment 8 score

Goal 4: Every young person in Luton is safe, skilled and equipped to be successful throughout their life

• 16-17 year olds not in education, employment or training (NEET) or whose activity is not known

• Statutory homelessness - households in temporary accommodation

Goal 5: Every adult in Luton is physically and mentally healthy and able to thrive

• Percentage of physically active adults • Estimated prevalence of common mental disorders in

people aged 16 and over Goal 6. Every adult in Luton has access to training to develop skills and access to good employment required to drive our commitment to eradicate poverty

• Percentage of people aged 16 - 64 in employment

Goal 7. Everyone in Luton lives in good quality housing, has access to green space and good air quality

• Homeless adults • Access to woodland • Air pollution: fine particulate matter • Utilisation of outdoor space for exercise/health reasons

Goal 8: Everyone in Luton has the level of meaningful social contact that they want

• Social Isolation: percentage of adult (18+ yrs) social care users who have as much social contact as they would like

• Social Isolation: percentage of adult (18+ yrs) carers who have as much social contact as they would like

Goal 9: Everyone in Luton lives the end of their life with dignity in the place of their choice.

• Percentage of deaths in usual place of residence (DiUPR) (All ages)

• Percentage of deaths that occur in hospital (All ages) • Deaths in Usual Place of Residence: People with dementia

(aged 65 years and over)

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AGENDA ITEM

7

DATE OF MEETING: 19 September 2019 REPORT OF: The Corporate Director Public Health and Wellbeing REPORT AUTHOR: Kate Sutherland SUBJECT: Luton Better Care Fund Template 2019-2020

WARD(S) AFFECTED: All PURPOSE 1. The purpose of the Better Care Fund submission to the Health and Wellbeing

Board is to obtain approval on the 2019-2020 Better Care Fund templates. The NHS England national templates replace the narrative local Better Care Fund Plan required in previous years.

2. The documents represent two parts of the whole; a main template and a

financial template, which will be merged in the next few days. The templates, jointly set out the Luton Better Care Fund investment position against national expectations and criteria, income and expenditure, High Impact Change Model status, Better Care Fund designated metrics, planning requirement compliance and a strategic narrative based on the key lines of enquiry outlined in the Better Care Fund Planning Requirements.

RECOMMENDATION(S) 3. It is recommended that the Board:

• Review the templates individually, starting with the main template and following on with the financial template

• Recognise that the content of the report represents the 2019-2020 business as usual service allocations, the CCG adult social care minimum spend, the Disability Fund Grant, winter pressure funding, change schemes and projects agreed at Joint Strategy Commissioning Group, October 2018

• Consider and comment on the narrative within the template, as outlined in section 3.2

• Final sign off from Chair required before submission to NHS England on the 23rd September.

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Please note; due to pressure against the submission timetable and aligned governance schedule, the templates will require minor additions, after the date circulated. Assurance is given to the Board that only two items are outstanding: 1. Main template and Finance template to be merged 2. A short paragraph is required, detailing the actions needed to

take the maturity level of the High Impact Change Model Home First/Discharge to Assess from mature to exemplary.

REPORTING 4. The NHS England Better Care Fund Plan Template provides an overview of

how the allocations support person centred care, Luton’s approach to integrated care, wider system level alignment, for example to the NHS Long Term Plan, the Health and Wellbeing Strategy and the Luton ‘At Place’ Single System Operating Plan.

5. Due to the tight timeframe and the scheduling for submission of documents to the Health and Wellbeing Board the BCF Template has been submitted in two parts:

1. Main document (Sheets 4,7,8 and 9) 2. Finance document (Sheets 3,5 and 6)

6. The following key points are highlighted:

Template one (1) sheet 4 provides a narrative view of Luton Better Care Fund Strategy associated with the key lines of enquiry detailed in the questions below:

1. Person centred, Luton’s approach to prevention, self-care,

choice and independence, including key schemes and projects. 2. Integrated services at health and wellbeing level and where

relevant neighbourhood level; joint commissioning arrangements, alignment to Primary Care Networks and the voluntary and community services.

3. Alignment with wider services e.g. Housing; Luton’s approach to the Disabilities Fund Grant, and strategic planning for adaptations and technology.

4. System level alignment; BCF’s alignment to the wider integration landscape e.g. the STP/ICS, include joint governance arrangements for BCF.

Template one (1) sheet 7, details the level of maturity against the High Impact Change Model. Luton is classified as a high performer against the High Impact Change Model objectives, five out of eight models are exemplary, a further two will attain exemplary in 2019-2020.

Template one (1) sheet 8, details the metrics set by the Better Care Fund Board for 2018-2019. The metrics will remain the same for 2019-2020. The sheet contains a narrative briefly outlining the plan for achieving the BCF metrics (A-D) in 2019-2020:

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1. Total number of acute non-elective spells per 100,000 of the

population – on track 2. Delayed transfers of care per day (daily delays) from hospital

(18+) – exemplary on track 3. Long term support needs of older people (65+) met by

admission to residential and nursing care homes (per 100,000 population) – sustainable – on track

4. The proportion of older people (65+) who were still at home 91 days after discharge from hospital into reablement or rehabilitation – on track

Template one (1) sheet 9, provides confirmation that Luton has met the key lines of enquiry as detailed in the Better Care Fund Planning Requirements. Template two (2) sheet 5, details the income received for 2019-2020. Please note that he winter pressure funding 2019-2020 now sits under the umbrella of BCF. Template two (2) sheet 6, details expenditure against the business as usual strategies, schemes and projects. BCF and iBCF 2019-2020 business as usual strategies, schemes and individual projects are a continuation from 2018-2019. In each case, a further year funding was deemed essential for the realisation of the benefits outlined in the business cases. The refreshed Business Cases for 2019-2020 were reviewed and approved by the Joint Strategic Commissioning Board, in October 2018. Early approval ensured BCF and iBCF allocations were finalised prior to the ratification of 2019 -2020 Luton Borough Council budget.

BACKGROUND 7. The Better Care Fund Plan Template publication was originally due for

release in February 2019. Delays at NHS England and Better Care Fund Board level continued, until the publication in August 2019. The submission date for the Luton Template is the 23rd September. Approval is sought from the Luton Health and Wellbeing Board prior to submission to NHS England on the 23rd September 2019.

8. Please note that the NHS England template is not an easy format to read. It

has been designed to provide a formulated platform for an equitably assessment of each Health and Wellbeing area, against the national conditions and criteria assigned to the fund. In order to prevent variation between each area’s spreadsheet the Better Care Fund administrators have locked the document cells. Unfortunately, this means, if printed, the narrative cannot be seen in full.

9. Guidance for reading the templates:

• The document must be read as an electronic document • Right click on each yellow box within the document, highlight the

narrative and scroll down to bring up the full narrative assigned to each box

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• Main Template – Sheets 2, 3,4,7,8 and 9. (Please ignore income and expenditure sheets 5 and 6)

• Finance Template – Sheets 5 and 6

OPPORTUNITIES 10. The initial goal is to understand the impact and opportunities the Long Term

Plan presents for Luton. In particular integration and co-production opportunities, including Primary Care Networks. The publication of the Green Papers, the Spending Review and the Workforce Plan will add significant depth to the process.

FINANCIAL IMPLICATIONS

11. There are no financial implications to this report since the funding has been

received and allocated in accordance with the conditions and criteria against the fund.

KEY RISKS 12. None noted

CONSULTATION ARRANGMENTS

13. Stakeholder engagement and partnership collaboration form part of the

project, schemes or fund managers responsibility. Issues or risks related to engagement or partnership arrangements are reported via the monthly highlight reports submitted by the project and scheme managers, ensuring robust arrangements and ongoing communication forms the backbone of each project and scheme.

APPENDICES Appendix A - Main Better Care Fund 2019-20 Template v5.0 Appendix B - Better Care Fund 2019-20 Finance Template v1.1 LIST OF BACKGROUND PAPERS LOCAL GOVERNMENT ACT 1972, SECTION 100D Papers in relation to drafting of the Better Care Fund Plan Template BCF Business Cases submitted to JSCG October 2019 prior to allocation BCF Project/Scheme Monthly Highlight Reports BCF Luton Programme Tracker BCF Policy Framework (Link) BCF Planning Requirements Guidance – (Link)

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https://www.gov.uk/government/publications/better-care-fund-how-it-will-work-in-2019-to-2020

https://www.gov.uk/government/publications/better-care-fund-planning-requirements-for-2019-to-2020

Better Care Fund 2019/20 Template1. Guidance

Overview

Note on entering information into this template

Throughout the template, cells which are open for input have a yellow background and those that are pre-populated have a grey background, as below:Data needs inputting in the cellPre-populated cellsNote on viewing the sheets optimallyFor a more optimal view each of the sheets and in particular the drop down lists clearly on screen, please change the zoom level between 90% - 100%. Most drop downs are also available to view as lists within the relevant sheet or in the guidance sheet for readability if required.

The details of each sheet within the template are outlined below.Checklist (click to go to Checklist, included in the Cover sheet)1. This section helps identify the data fields that have not been completed. All fields that appear as incomplete should be complete before sending to the Better Care Support Team.2. It is sectioned out by sheet name and contains the description of the information required, cell reference for the question and the 'checker' column which updates automatically as questions within each sheet are completed.3. The checker column will appear 'Red' and contain the word 'No' if the information has not been completed. Clicking on the corresponding 'Cell Reference' column will link to the incomplete cell for completion. Once completed the checker column will change to 'Green' and contain the word 'Yes'

4. The 'sheet completed' cell will update when all 'checker' values for the sheet are green containing the word 'Yes'.5. Once the checker column contains all cells marked 'Yes' the 'Incomplete Template' cell (below the title) will change to 'Complete Template'.6. Please ensure that all boxes on the checklist are green before submission.2. Cover (click to go to sheet)1. The cover sheet provides essential information on the area for which the template is being completed, contacts and sign off.

2. Question completion tracks the number of questions that have been completed; when all the questions in each section of the template have been completed the cell will turn green. Only when all cells are green should the template be sent to [email protected]. Please note that in line with fair processing of personal data we collect email addresses to communicate with key individuals from the local areas for various purposes relating to the delivery of the BCF plans including plan development, assurance, approval and provision of support. We remove these addresses from the supplied templates when they are collated and delete them when they are no longer needed. Please let us know if any of the submitted contact information changes during the BCF planning cycle so we are able to communicate with the right people in a timely manner.

4. Strategic Narrative (click to go to sheet)This section of the template should set out the agreed approach locally to integration of health & social care. The narratives should focus on updating existing plans, and changes since integration plans were set out until 2020 rather than reiterating them and can be short. Word limits have been applied to each section and these are indicated on the worksheet.

1. Approach to integrating care around the person. This should set out your approach to integrating health and social care around the people, particularly those with long term health and care needs. This should highlight developments since 2017 and cover areas such as prevention.

2 i. Approach to integrating services at HWB level (including any arrangements at neighbourhood level where relevant). This should set out the agreed approach and services that will be commissioned through the BCF. Where schemes are new or approaches locally have changed, you should set out a short rationale.2 ii. DFG and wider services. This should describe your approach to integration and joint commissioning/delivery with wider services. In all cases this should include housing, and a short narrative on use of the DFG to support people with care needs to remain independent through adaptations or other capital expenditure on their homes. This should include any discretionary use of the DFG.3. How your BCF plan and other local plans align with the wider system and support integrated approaches. Examples may include the read across to the STP (Sustainability Transformation Partnerships) or ICS (Integrated Care Systems) plan(s) for your area and any other relevant strategies.

You can attach (in the e-mail) visuals and illustrations to aid understanding if this will assist assurers in understanding your local approach.5. Income (click to go to sheet)

1. This sheet should be used to specify all funding contributions to the Health and Wellbeing Board's Better Care Fund (BCF) plan and pooled budget for 2019/20. On selected the HWB from the Cover page, this sheet will be pre-populated with the minimum CCG contributions to the BCF, DFG (Disabled Facilities Grant), iBCF (improved Better Care Fund) and Winter Pressures allocations to be pooled within the BCF. These cannot be edited.2. Please select whether any additional contributions to the BCF pool are being made from Local Authorities or the CCGs and as applicable enter the amounts in the fields highlighted in ‘yellow’. These will appear as funding sources when planning expenditure. The fields for Additional contributions can be utilised to include any relevant carry-overs from the previous year.3. Please use the comment boxes alongside to add any specific detail around this additional contribution including any relevant carry-overs assigned from previous years. All allocations are rounded to the nearest pound.4. For any questions regarding the BCF funding allocations, please contact [email protected]

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6. Expenditure (click to go to sheet)This sheet should be used to set out the schemes that constitute the BCF plan for the HWB including the planned expenditure and the attributes to describe the scheme. This information is then aggregated and utilised to analyse the BCF plans nationally and sets the basis for future reporting and to particularly demonstrate that National Condition 2 and 3 are met.

The table is set out to capture a range of information about how schemes are being funded and the types of services they are providing. There may be scenarios when several lines need to be completed in order to fully describe a single scheme or where a scheme is funded by multiple funding streams (eg: iBCF and CCG minimum). In this case please use a consistent scheme ID for each line to ensure integrity of aggregating and analysing schemes.On this sheet please enter the following information:1. Scheme ID:- This field only permits numbers. Please enter a number to represent the Scheme ID for the scheme being entered. Please enter the same Scheme ID in this column for any schemes that are described across multiple rows.2. Scheme Name: - This is a free field to aid identification during the planning process. Please use the scheme name consistently if the scheme is described across multiple lines in line with the scheme ID described above.3. Brief Description of Scheme- This is free text field to include a brief headline description of the scheme being planned.4. Scheme Type and Sub Type: - Please select the Scheme Type from the drop-down list that best represents the type of scheme being planned. A description of each scheme is available at the end of the table (follow the link to the description section at the top of the main expenditure table). - Where the Scheme Types has further options to choose from, the Sub Type column alongside will be editable and turn "yellow". Please select the Sub Type from the drop down list that best describes the scheme being planned.- Please note that the drop down list has a scroll bar to scroll through the list and all the options may not appear in one view.- If the scheme is not adequately described by the available options, please choose ‘Other’ and add a free field description for the scheme type in the column alongside.- While selecting schemes and sub-types, the sub-type field will be flagged in ‘red’ font if it is from a previously selected scheme type. In this case please clear the sub-type field and reselect from the dropdown if the subtype field is editable.

5. Planned Outputs- The BCF Planning requirements document requires areas to set out planned outputs for certain scheme types (those which lend themselves to delivery of discrete units of delivery) to help to better understand and account for the activity funded through the BCF. - The Planned Outputs fields will only be editable if one of the relevant scheme types is selected. Please select a relevant unit from the drop down and an estimate of the outputs expected over the year. This is a numerical field.6. Metric Impact- This field is collecting information on the metrics that a chem will impact on (rather than the actual planned impact on the metric)- For the schemes being planned please select from the drop-down options of ‘High-Medium-Low-n/a’ to provide an indicative level of impact on the four BCF metrics. Where the scheme impacts multiple metrics, this can be expressed by selecting the appropriate level from the drop down for each of the metrics. For example, a discharge to assess scheme might have a medium impact on Delayed Transfers of Care and permanent admissions to residential care. Where the scheme is not expected to impact a metric, the ‘n/a’ option could be selected from the drop-down menu.7. Area of Spend:- Please select the area of spend from the drop-down list by considering the area of the health and social system which is most supported by investing in the scheme. - Please note that where ‘Social Care’ is selected and the source of funding is “CCG minimum” then the planned spend would count towards National Condition 2.- If the scheme is not adequately described by the available options, please choose ‘Other’ and add a free field description for the scheme type in the column alongside. - We encourage areas to try to use the standard scheme types where possible.8. Commissioner:- Identify the commissioning entity for the scheme based on who commissions the scheme from the provider. If there is a single commissioner, please select the option from the drop-down list. - Please note this field is utilised in the calculations for meeting National Condition 3.- If the scheme is commissioned jointly, please select ‘Joint’. Please estimate the proportion of the scheme being commissioned by the local authority and CCG/NHS and enter the respective percentages on the two columns alongside.9. Provider:- Please select the ‘Provider’ commissioned to provide the scheme from the drop-down list.- If the scheme is being provided by multiple providers, please split the scheme across multiple lines.

10. Source of Funding:- Based on the funding sources for the BCF pool for the HWB, please select the source of funding for the scheme from the drop-down list- If the scheme is funding across multiple sources of funding, please split the scheme across multiple lines, reflecting the financial contribution from each.11. Expenditure (£) 2019/20:- Please enter the planned spend for the scheme (or the scheme line, if the scheme is expressed across multiple lines)12. New/Existing Scheme- Please indicate whether the planned scheme is a new scheme for this year or an existing scheme being carried forward.

This is the only detailed information on BCF schemes being collected centrally for 2019/20 and will inform the understanding of planned spend for the iBCF and Winter Funding grants.

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7. HICM (click to go to sheet)

National condition four of the BCF requires that areas continue to make progress in implementing the High Impact Change model for managing transfers of care and continue to work towards the centrally set expectations for reducing DToC. In the planning template, you should provide:- An assessment of your current level of implementation against each of the 8 elements of the model – from a drop-down list- Your planned level of implementation by the end March 2020 – again from a drop-down listA narrative that sets out the approach to implementing the model further. The Narrative section in the HICM tab sets out further details.8. Metrics (click to go to sheet)This sheet should be used to set out the Health and Wellbeing Board's performance plans for each of the Better Care Fund metrics in 2019/20. The BCF requires plans to be agreed for the four metrics. This should build on planned and actual performance on these metrics in 2018/19.

1. Non-Elective Admissions (NEA) metric planning:- BCF plans as in previous years mirror the latest CCG Operating Plans for the NEA metric. Therefore, this metric is not collected via this template.

2. Residential Admissions (RES) planning: - This section requires inputting the information for the numerator of the measure.- Please enter the planned number of council-supported older people (aged 65 and over) whose long-term support needs will be met by a change of setting to residential and nursing care during the year (excluding transfers between residential and nursing care) for the Residential Admissions numerator measure.- The prepopulated denominator of the measure is the size of the older people population in the area (aged 65 and over) taken from ONS subnational population projections.- The annual rate is then calculated and populated based on the entered information.- Please include a brief narrative associated with this metric plan

3. Reablement (REA) planning: - This section requires inputting the information for the numerator and denominator of the measure.- Please enter the planned denominator figure, which is the planned number of older people discharged from hospital to their own home for rehabilitation (or from hospital to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on/back to their own home).- Please then enter the planned numerator figure, which is the planned number of older people discharged from hospital to their own home for rehabilitation (from within the denominator) that will still be at home 91 days after discharge.- The annual proportion (%) Reablement measure will then be calculated and populated based on this information.- Please include a brief narrative associated with this metric plan

4. Delayed Transfers of Care (DToC) planning: - The expectations for this metric from 2018/19 are retained for 2019/20 and these are prepopulated. - Please include a brief narrative associated with this metric plan. - This narrative should include details of the plan, agreed between the local authority and the CCG for using the Winter Pressures grant to manage pressures on the system over Winter.9. Planning Requirements (click to go to sheet)This sheet requires the Health & Wellbeing Board to confirm whether the National Conditions and other Planning Requirements detailed in the BCF Policy Framework and the BCF Requirements document are met. Please refer to the BCF Policy Framework and BCF Planning Requirements documents for 2019/20 for further details.The Key Lines of Enquiry (KLOE) underpinning the Planning Requirements are also provided for reference as they will be utilised to assure plans by the regional assurance panel.1. For each Planning Requirement please select ‘Yes’ or ‘No’ to confirm whether the requirement is met for the BCF Plan.2. Where the confirmation selected is ‘No’, please use the comments boxes to include the actions in place towards meeting the requirement and the target timeframes.10. CCG-HWB Mapping (click to go to sheet)

The final sheet provides details of the CCG - HWB mapping used to calculate contributions to Health and Wellbeing Board level non-elective activity figures.

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Version 0.1

Please Note:

Yes10/10/2019

Professional Title (where applicable) First-name: Surname: E-mail:

*Area Assurance Contact Details:Councillor Hazel Simonds [email protected].

ukSee: Chief Operating Officer

N/A N/A N/A@

N/A N/A N/A N/A@

Luton Borough Council Chief

Robin Porter [email protected]

DASS & Corporate

Gerry Taylor [email protected]

Programme Manager Public

Kate Sutherland [email protected]

Service Director Finance and

Dev Gopal [email protected]

Luton CCG Chief Operating Officer

Nicky Poulain [email protected]

Finance Business Partner

Atif Iqbal [email protected]

Deputy Chief Finance Officer

Liz Cox [email protected]

Please add further area contacts that you would wish to be included in

official correspondence --> Luton Borough Council, BCF Finance Lead

Luton CCG, BCF Finance Lead

Role:Health and Wellbeing Board Chair

Clinical Commissioning Group Accountable Officer (Lead)

Additional Clinical Commissioning Group(s) Accountable Officers

Local Authority Chief Executive

Local Authority Director of Adult Social Services (or equivalent)

Better Care Fund Lead Official

LA Section 151 Officer

Luton CCG Chief Operating Officer

Who signed off the report on behalf of the Health and Wellbeing Board:

Better Care Fund 2019/20 Template2. Cover

Kate Sutherland

[email protected]

Luton

01582 548438

Health and Wellbeing Board:

Completed by:

E-mail:

Contact number:

- You are reminded that much of the data in this template, to which you have privileged access, is management information only and is not in the public domain. It is not to be shared more widely than is necessary to complete the return.- Please prevent inappropriate use by treating this information as restricted, refrain from passing information on to others and use it only for the purposes for which it is provided. Any accidental or wrongful release should be reported immediately and may lead to an inquiry. Wrongful release includes indications of the content, including such descriptions as "favourable" or "unfavourable".- Please note that national data for plans is intended for release in aggregate form once plans have been assured, agreed and baselined as per the due process outlined in the BCF Planning Requirements for 2019/20.- This template is password protected to ensure data integrity and accurate aggregation of collected information. A resubmission may be required if this is breached.

Nicky Poulain, CCG Accountable Officer, Gerry Taylor, LBC Corpora

Will the HWB sign-off the plan after the submission date?If yes, please indicate the date when the HWB meeting is scheduled:

*Only those identified will be addressed in official correspondence (such as approval letters). Please ensure all individuals are satisfied with the information entered above as this is exactly how they will appear in correspondence.

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Complete:2. Cover Yes4. Strategic Narrative No5. Income Yes6. Expenditure No7. HICM Yes8. Metrics Yes9. Planning Requirements Yes

2. Cover ^^ Link back to topCell Reference CheckerD13 YesD15 YesD17 YesD19 YesD21 YesD23 YesD24 YesC27 : C36 YesF27 : F36 YesG27 : G36 YesH27 : H36 Yes

Yes

4. Strategic Narrative ^^ Link back to topCell Reference CheckerB20 YesB31 NoB37 YesB44 Yes

No

5. Income ^^ Link back to topCell Reference CheckerC39 YesB42 : B44 YesC42 : C44 YesD42 : D44 YesC59 YesB62 : B71 YesC62 : C71 YesD62 : D71 Yes

Yes

Area Assurance Contact Details - First name:Area Assurance Contact Details - Surname:

Sheet Complete

Are any additional CCG Contributions being made in 2019/20?Additional CCGsAdditional CCG Contribution

Area Assurance Contact Details - E-mail:

Are any additional LA Contributions being made in 2019/20?

C) System level alignment:

<< Link to the Guidance sheet

Checklist

A) Person-centred outcomes:B) (i) Your approach to integrated services at HWB level (and neighbourhood where applicable):B) (ii) Your approach to integration with wider services (e.g. Housing):

Question Completion - when all questions have been answered and the validation boxes below have turned green you should send the template to [email protected] saving the file as 'Name HWB' for example 'County Durham HWB'

Contact number:Who signed off the report on behalf of the Health and Wellbeing Board:

Sheet Complete

Please see the Checklist below for further details on incomplete fields

Health & Wellbeing BoardCompleted by:E-mail:

Area Assurance Contact Details - Role:

Additional CCG Contribution Narrative

Sheet Complete

Additional Local AuthorityAdditional LA ContributionAdditional LA Contribution Narrative


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6. Expenditure ^^ Link back to topCell Reference CheckerB22 : B271 YesC22 : C271 YesD22 : D271 NoE22 : E271 NoF22 : F271 YesG22 : G271 YesH22 : H271 YesI22 : I271 YesJ22 : J271 NoK22 : K271 NoL22 : L271 NoM22 : M271 NoN22 : N271 NoO22 : O271 YesP22 : P271 NoQ22 : Q271 YesS22 : S271 NoT22 : T271 NoU22 : U271 NoV22 : V271 No

No

7. HICM ^^ Link back to topCell Reference CheckerB11 YesD15 YesD16 YesD17 YesD18 YesD19 YesD20 YesD21 YesD22 YesE15 YesE16 YesE17 YesE18 YesE19 YesE20 YesE21 YesE22 YesF15 YesF16 YesF17 YesF18 YesF19 YesF20 YesF21 YesF22 Yes

Yes

Chg 7) Focus on choice - Current Level:Chg 8) Enhancing health in care homes - Current Level:

Provider:Source of Funding:Expenditure:New/Existing Scheme:

Sheet Complete

Impact: Reablement:Area of Spend:Specify if area of spend is Other:Commissioner:Joint Commissioner %:

Planned Output:Planned Output Unit Estimate:

Scheme ID:

Chg 1) Early discharge planning - Current Level:Chg 2) Systems to monitor patient flow - Current Level:Chg 3) Multi-disciplinary/Multi-agency discharge teams - Current Level:Chg 4) Home first / discharge to assess - Current Level:Chg 5) Seven-day service - Current Level:Chg 6) Trusted assessors - Current Level:

Impact: Delayed Transfers of Care:Impact: Residential Admissions:

Sub Types:

Scheme Name:Brief Description of Scheme:Scheme Type:

Specify if scheme type is Other:

Impact: Non-Elective Admissions:

Priorities for embedding elements of the HCIM for Managing Transfers of Care locally:

Chg 1) Early discharge planning - Planned Level:Chg 2) Systems to monitor patient flow - Planned Level:Chg 3) Multi-disciplinary/Multi-agency discharge teams - Planned Level:Chg 4) Home first / discharge to assess - Planned Level:Chg 5) Seven-day service - Planned Level:Chg 6) Trusted assessors - Planned Level:Chg 7) Focus on choice - Planned Level:Chg 8) Enhancing health in care homes - Planned Level:

Sheet Complete

Chg 1) Early discharge planning - Reasons:Chg 2) Systems to monitor patient flow - Reasons:Chg 3) Multi-disciplinary/Multi-agency discharge teams - Reasons:Chg 4) Home first / discharge to assess - Reasons:Chg 5) Seven-day service - Reasons:Chg 6) Trusted assessors - Reasons:Chg 7) Focus on choice - Reasons:Chg 8) Enhancing health in care homes - Reasons:

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8. Metrics ^^ Link back to topCell Reference CheckerE10 YesE17 YesF27 YesG26 YesF39 YesF40 YesG38 Yes

Yes

9. Planning Requirements ^^ Link back to topCell Reference CheckerF8 YesF9 YesF10 YesF11 YesF12 YesF13 YesF14 YesF15 YesF16 YesH8 YesH9 YesH10 YesH11 YesH12 YesH13 YesH14 YesH15 YesH16 YesI8 YesI9 YesI10 YesI11 YesI12 YesI13 YesI14 YesI15 YesI16 Yes

Yes

^^ Link back to top

Non-Elective Admissions: Overview Narrative:Delayed Transfers of Care: Overview Narrative:Residential Admissions Numerator:Residential Admissions: Overview Narrative:Reablement Numerator:

Sheet Complete

PR5: NC3: NHS commissioned Out of Hospital Services - Actions in place if not

PR2: NC1: Jointly agreed plan - Timeframe if not metPR3: NC1: Jointly agreed plan - Timeframe if not metPR4: NC2: Social Care Maintenance - Timeframe if not metPR5: NC3: NHS commissioned Out of Hospital Services - Timeframe if not metPR6: NC4: Implementation of the HICM for Managing Transfers of Care - Timeframe if not metPR7: Agreed expenditure plan for all elements of the BCF - Timeframe if not metPR8: Agreed expenditure plan for all elements of the BCF - Timeframe if not metPR9: Metrics - Timeframe if not met

PR1: NC1: Jointly agreed plan - Actions in place if notPR2: NC1: Jointly agreed plan - Actions in place if not

PR1: NC1: Jointly agreed plan - Plan to Meet

PR6: NC4: Implementation of the HICM for Managing Transfers of Care - Actions in place if notPR7: Agreed expenditure plan for all elements of the BCF - Actions in place if notPR8: Agreed expenditure plan for all elements of the BCF - Actions in place if notPR9: Metrics - Actions in place if notPR1: NC1: Jointly agreed plan - Timeframe if not met

PR3: NC1: Jointly agreed plan - Actions in place if notPR4: NC2: Social Care Maintenance - Actions in place if not

PR2: NC1: Jointly agreed plan - Plan to MeetPR3: NC1: Jointly agreed plan - Plan to MeetPR4: NC2: Social Care Maintenance - Plan to MeetPR5: NC3: NHS commissioned Out of Hospital Services - Plan to MeetPR6: NC4: Implementation of the HICM for Managing Transfers of Care - Plan to MeetPR7: Agreed expenditure plan for all elements of the BCF - Plan to MeetPR8: Agreed expenditure plan for all elements of the BCF - Plan to MeetPR9: Metrics - Plan to Meet

Reablement Denominator:Reablement: Overview Narrative:

Sheet Complete

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Income Expenditure Difference£1,417,554 £0 £1,417,554

£13,888,448 £0 £13,888,448£6,472,833 £0 £6,472,833

£788,125 £0 £788,125£0 £0 £0£0 £0 £0

£22,566,960 £0 £22,566,960

£3,946,703£0 Planned spend is less than the minimum required spend

£6,344,639£0 Planned spend is less than the minimum required spend

£0£0£0£0£0£0£0£0£0£0£0£0£0£0£0£0£0

Income & Expenditure

Selected Health and Wellbeing Board: Luton

NHS Commissioned Out of Hospital spend from the minimum CCG allocation

Funding Sources

Income >>

Total

Planned spend

Minimum required spendPlanned spend

Assistive Technologies and EquipmentCare Act Implementation Related Duties

Scheme Types

Other

Personalised Care at Home

Adult Social Care services spend from the minimum CCG allocations

Carers ServicesCommunity Based SchemesDFG Related SchemesEnablers for IntegrationHICM for Managing Transfer of CareHome Care or Domiciliary CareHousing Related Schemes

Expenditure >>

Integrated Care Planning and NavigationIntermediate Care ServicesPersonalised Budgeting and Commissioning

Better Care Fund 2019/20 Template3. Summary

DFGMinimum CCG ContributioniBCFWinter Pressures GrantAdditional LA ContributionAdditional CCG Contribution

Total

Minimum required spend

Prevention / Early InterventionResidential Placements

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Chg 1 Early discharge planning

Chg 2 Systems to monitor patient flow

Chg 3Multi-disciplinary/Multi-agency discharge teams

Chg 4 Home first / discharge to assess

Chg 5 Seven-day service

Chg 6 Trusted assessors

Chg 7 Focus on choice

Chg 8 Enhancing health in care homes

19/20 Plan

Annual Rate 638.7797802

19/20 Plan

Annual (%) 0.825

Theme Code Response

PR1 Yes

PR2 Yes

PR3 Yes

PR4 Yes

PR5 Yes

PR6 Yes

PR7 Yes

PR8 Yes

PR9 Yes

Exemplary

Mature

Exemplary

Exemplary

Exemplary

Exemplary

Mature

Planned level of maturity for 2019/2020

Exemplary

Go to Better Care Exchange >>

Metrics

HICM >>

Planning Requirements >>

Reablement

Residential Admissions

Non-Elective AdmissionsDelayed Transfer of Care

NC2: Social Care Maintenance

NC3: NHS commissioned Out of Hospital Services

NC4: Implementation of the High Impact Change Model for Managing Transfers of Care

Metrics >>

NC1: Jointly agreed plan

Agreed expenditure plan for all elements of the BCF

Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services

Long-term support needs of older people (age 65 and over) met by admission to residential and nursing care homes, per 100,000 population

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https://future.nhs.uk/connect.ti/bettercareexchange/view?objectId=51593157


Please outline your approach towards integration of health & social care:

Link to B) (i)Link to B) (ii)Link to C)

Remaining Word Limit: 18

Better Care Fund 2019/20 Template4. Strategic Narrative

- Prevention and self-care- Promoting choice and independence

When providing your responses to the below sections, please highlight any learning from the previous planning round (2017-2019) and cover any priorities for reducing health inequalities under the Equality Act 2010.

A) Person-centred outcomesYour approach to integrating care around the person, this may include (but is not limited to):

Through a jointly agreed one year 'At Place' Single System Operating plan, underpinned by the Health and Wellbeing Strategy and the Long Term Plan, Luton will continue to build on the person centred ambitions and commitment to the population we serve.

The Luton Better Care Fund, programme is a direct enabler of the Luton 'At Place' Single System Operating Plan and the Health and Wellbeing Strategy. The programme is synergystic with the wider integration plans across the BLMK footprint, the Luton Borough Council Joint Strategic Needs Assessment and the Luton BoroughCouncil 2040 vision; erradicating poverty. In 2019-2020 the business cases allocated BCF or iBCF funding, remain a continuation of the jointly approved health and social care schemes in 2018-2019. Allocations included key 'business as usual' strategic support, change schemes and individual projects. Expedited by the Better Care Fund, Luton aims to educate, support and empower people to manage their own health, make informed decisions about their care and treatment, improve their health and wellbeing, in order to provide the opportunity to lead the best life they can. Luton remains committed to a whole system, population health approach, built solidly on person centred outcomes.

Operating from an evidence based protocol, the Joint Strategic Commissioning Group have commissioned the development of a Joint Outcomes Framework. The Framework is a Luton specific control tool, providing key data influencing person centred outcomes within the whole system. The Framework is now live and will be presented to the Joint Strategic Commissioning Group on a quarterly basis. Reports will provide a shared understanding of the positive and negative implications of the outcomes on the system and the people of Luton. The data and mapping facility will open up opportunities to proactively respond to concerns, issues, risk and needs, thereby influencing the system and enhancing the benefits at the core of our agenda. The Luton Joint Outcomes Framework corroborates the importance of shared data and transparency as an essential tool when addressing system integration and population health.

Examples of 2019-2020 BCF and iBCF allocations supporting person centred outcomes:

1. Cambridge Community Service Contract & At Home First Enhanced Models of Care - funding supports a multi-agency approach focused on how Cambridge Community Services, the co-ordinating provider, co-working with system partners, maximise the health, well-being, and independence and minimise or avoid exacerbations of their conditions, with the aim to reduce unplanned admissions.

2. Disability Resource Centre Carers Support - In the context of Luton Carers contribution to the local economy is estimated to be worth £386M. With over 4000 carers contributing more than 50 hours of support per week, their value has considerable significance for health and social care budgets. That support comes at a personal cost to the carer, particularly in relation to their own health and lifestyle. The funding allocated to the Disability Resource service focuses on preventing poor physical and mental health. The project ensure carers get the right support locally with information advice, guidance, including 'how to's' for example accessing benefits, peer support networks, activities and edcuational days to help them care for themselves and enable them to continue to support the cared for person. More specifically the outcomes include : • Carers have the information they need to care safely and sustainably and to pursue their choices • Carers are recognised as expert partners • Carers can access breaks from their caring role • Carer can cope with changes including when caring ends • Carers are well informed about benefits • Carers are in good physical and emotional health • Carers and their families live in appropriate housing

Please note that there are 4 responses required below, for questions: A), B(i), B(ii) and C)

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^^ Link back to topRemaining Word Limit: 0 Please do not exceed the word limit

- Joint commissioning arrangements

B) HWB level

- Alignment with primary care services (including PCNs (Primary Care Networks))- Alignment of services and the approach to partnership with the VCS (Voluntary and Community Sector)

Primary Care Networks (PCNs) - context for delivery in Luton

Responsive, proactive and accessible primary care needs to be led by general practice. It must be delivered in partnership with a wide range of professionals who are supported to better understand the health and wellbeing needs of the local communities they serve. 'At Place' in Luton and in close partnership with BLMK ICS, we see this being achieved through an enhanced delivery model, which in design and as an operating model, draws inspiration from the Primary Care Home (PCH) model. The integration of community health, mental health and social care services with primary care clinicians is crucial. However, this integration will be only be effective and sustainable if services are co-designed with GPs and communities, as a wrapped around, strengthened and scaled primary care delivery model.Luton is currently co-designing a resilient, multi-disciplinary and high quality primary care system in the heart of our local community. GPs will be at the centre of patient care, supporting and directing the provision and co-ordination of high quality medical care and treatment for those that are ill, but also in bringing about improved health and well-being for our population as a whole. The new model of care ‘a complete care community’ is built around patients and for patients, ensuring they receive the Right Care in the Right Place at the Right Time. How the BCF plan supports the development of PCNs:All PCNs are encouraged to consistently evaluate their progress as they develop their emerging ‘new care models’. This includes:• Identifying and agreeing system and PCN population health priorities• Having a clear definition of the change that is required as a result of the population health intervention• A balance of measures are agreed and in place to inform PCH decisions• The PCN routinely reviews its chosen metrics• Evaluation data is used to facilitate a collective approach to local resource management

The following BCF/iBCF initiatives will enable the development of PCNs and support development of their emerging care models:

• Systems integration supported by technology• Population Management and Self Care Project• Enhanced care in care homes• Social prescription• All initiatives related to the development of integrated teams

Working to the principles of the Luton Health & Wellbeing Strategy (“A Healthier Future – Improving Health and Wellbeing in Luton 2012 to 2019”), the BCF Plan 2019-20 commitment continues towards the increasing development of integrated community services, built solidly around a proactive and effective primary care system. Having achieved significant success around Delayed Transfers of Care, Luton is focusing on the reduction of non-elective admissions and providing effective, quality care within the community. An Out of Hospital strategy and associated model has been developed, further enabling health and care professionals to provide improved and integrated pathways for the people of Luton. The Out of Hospital model will form the foundation stone for improved community care. This is aligned to the Better Care Funding allocated to existing service contracts, supporting increased capacity and subsequent innovative changes within the system Schemes such as Community Based Prevention the Integrated Rapid Response & the Reablement are key to enabling preventative care closer to home

(i) Your approach to integrated services at HWB level (and neighbourhood where applicable), this may include (but is not limited to):

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^^ Link back to topRemaining Word Limit: 156

- Your approach to using the DFG to support the housing needs of people with disabilities or care needs. This should include any arrangements for strategic planning for the use of adaptations and technologies to support independent living in line with the

BCF plan for 2019-20 is aligned with The Luton Borough Council and the Luton Clinical Commissioning Group Section 75 Partnership Agreement 2018-21. The S75 provides structure and agreement for new ways of working, staffing arrangements, pooled, non-pooled, aligned budgets and risk share arrangements. A refresh for 2019-2020 is underway and schedules have been drafted pending agreement of the BCF Pln 2019-2020.

S75 2019-2020 Schedules:1. Integrated Children & Young Peoples Commissioning2. Commissioning Integrated Mental Health & Wellbeing3. Learning Disabilities and Autism4. Better Care Fund and the Improved Better Care Fund 5. Joint Commissioning Arrangements and Joint Posts6.The Joint Strategic Commissioning Group7.Financial Arrangements8. GDPR9. Equality & Diversity Service10. Integrated Translation & Interpretation Service

Joint working arrangements between specific services have been outlined in the S75 Schedule 5, Joint Commissioning Arrangements and Joint Posts. The schedule outlines the interdependency between commissioning local comprehensive maternity services and heath visiting services. It is imperative the CCG and LA work in partnership to ensure best outcomes to women and neonates. Luton Council commission health visitor services to in-reach within the antenatal care period for pregnant women to ensure early identification of risk or additional need and to provide a smooth transition post-delivery. Additionally, the Luton Council Public Health Team commission a public health midwife to develop and ensure delivery of pathways to improve the health of this population, including vaccinations, weight management and smoking.

Luton continues to work collaboratively on ways to commission differently, placing patient experience and outcomes at the centre of the commissioning strategy . In 2019 the Luton Total Wellbeing Service became the first jointly commissioned service. Total Wellbeing is an integrated provision, offering healthy lifestyle support, social prescription and Improving Access to Psychological Therapies (IAPT) services. The holistic and collaborative approach exemplifies the whole person approach to wellbeing. Luton commissioning intentions are to develop further opportunities to jointly commission services, building on the whole system approach to commissioning

Co-location of Luton Borough Council, Public Health and Wellbeing Directorate, which includes adults and childrens commissioning and Luton Clinical Commissioning Group is helping to drive forward a whole system population approach; strengthening relationships and providing a platform for closer collaboration and further integration opportunities. The benefits of day to day informal conversations, impromptu meetings, shared environment and cultural merging are strengthening relationships, common values and objectives, whilst engendering the ethos of a one system team.

As per DFG grant determination 2019-20, DFG allocation for Luton is £1,417,554. The strategy for 2019-2020 is to continue to build on the good work carried out in 2018-2019. For council properties the council has a programme of extensions that are used to enable disabled people to access suitable h i Th i i f ll i t t d i t th ti l th i f b th hild d d lt Th i d t b ild l d t d h i th i bli l f ili ith b h i di bl d t li i d d tl Th il’ it l f th t

(ii) Your approach to integration with wider services (e.g. Housing), this should include:

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C) System level alignment, for example this may include (but is not limited to):- How the BCF plan and other plans align to the wider integration landscape, such as STP/ICS plans- A brief description of joint governance arrangements for the BCF plan

Through inclusive and collaborative consultation, shared decision making and consenus, national and local plans and strategies; including the NHS Long term Plan, the Luton 1 yr Single System Operating Plan, the Luton Health & Wellbeing Strategy, the Luton Borough Council Joint Strategic Needs Assessment and Luton 2025, have been integrated into the BCF Plan and the funding allocations assigned therein.

The 'At Place' and the BLMK plans cohesively outline a whole system approach, of which BCF and iBCF are a key enablers. The vision underpinning system level alignment, serves to inspire and motivate stakeholder partnerships and collaboration, to address issues at the heart of the communities and people we serve; life expectancy, health inequalities, morbidity and mortality, wider determinants of health, health behaviours and risk factors.

In adopting a 'House of Care' philosophy; a single system approach to health and care for Luton, joint plans include:

• Population health - embedding the approach and focusing on identifed and agreed priorities• Prevention - preventing ill health, promoting good health by giving people • Primary, community and social care co-working, collaboration and integration• Sustainabilty of secondary care - admission prevention and impacting further on delayed transfers of care• Digitalisation - maximising the use of information technology and the inherent data to support the delivery of whole system care• Redesign - working together to make sure tha the right services are available at the right time and produce the outcomes defined in the At Place and wider integration plans

Examples of BCF BAU strategies, schemes and individual projects aligned to the At Place and the wider integration plans:

• ASC Side by Side - 3 conversations - new ways of working - encouraging independence for as long as possible - empowerment, self direction and dignity• Population Management and Self Care scheme - independence & self care programme to prevent escalation into social care & reduce care package cost. Long term educational innitiative• Early Supported Discharge - early stroke dicharge into community rehabilitation - prevention of readmission - quality of life• Enhanced Health in Care Homes - incoporating End of Life and Falls projects - improving the quality of life, healthcare and health planning for people living in care homes, end of life care and falls prevention• Luton Housing First - addressing entrenched homelessness - collaborative apporach• Integrated IAG Model - single point of access for information, advice and guidance for services in Luton• STEPS - effective discharge from mental health units in ccommunity care - approriate placement & care package• Reablement - enhancing short term support for individuals who have experienced an accident, medical crisis or change in circumstance, with the primary goal to obtain independence again

The Joint Outcomes Framework, detailed in question B, ensures that Luton has a joint and comprehensive data source from which to measure the successes, risks and opportunities At Place and in thewider integration landscape. The Framework is able to map across system outcomes, demonstrating the incremental integrated impact of the aligned plans

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Selected Health and Wellbeing Board:

Disabled Facilities Grant (DFG) Gross Contribution

Luton £1,417,554

123456789

101112

Total Minimum LA Contribution (exc iBCF) £1,417,554

iBCF Contribution ContributionLuton £6,472,833

Total iBCF Contribution £6,472,833

Winter Pressures Grant ContributionLuton £788,125

Total Winter Pressures Grant Contribution £788,125

Are any additional LA Contributions being made in 2019/20? If yes, please detail below No

Local Authority Additional Contribution Contribution

Total Additional Local Authority Contribution £0

Better Care Fund 2019/20 Template5. Income

DFG breakerdown for two-tier areas only (where applicable)

Local Authority Contribution

Comments - please use this box clarify any specific uses or sources of funding

Luton

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CCG Minimum Contribution Contribution1 NHS Luton CCG £13,888,448234567

Total Minimum CCG Contribution £13,888,448

Are any additional CCG Contributions being made in 2019/20? If yes, please detail below No

Additional CCG Contribution Contribution

Total Addition CCG Contribution £0Total CCG Contribution £13,888,448

2019/20Total BCF Pooled Budget £22,566,960

Funding Contributions CommentsOptional for any useful detail e.g. Carry overThe above plan assumes the receives the additional allocation notified by NHSE. If that allocation is not received, then the contribution to social care will reduce accordingly.

The Winter Pressure FundingLuton has maintained excellent performance in relation to DTOC in particular social care. Moving people out of hospital efficiently results in


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Planned spend is less than the minimum required spend

Planned spend is less than the minimum required spend

Link to Scheme Type descriptionScheme

IDScheme Name Brief Description of

SchemeScheme Type Sub Types Please specify if

'Scheme Type' is 'Other'

Planned Output Unit

Planned Output

Estimate

NEA DTOC RES REA Area of Spend

Please specify if 'Area of Spend'

is 'other'

Commissioner % NHS (if Joint Commissioner)

% LA (if Joint Commissioner)

Provider Source of Funding

Expenditure (£) New/ Existing Scheme

1 Joint Commissioning: Mental Health Contract

2 HICM: Acute Commuity Care Team

2 HICM: Co-ordinating Provider role

2 HICM: Integrated Discharge Team

2 HICM: Nursing Co-ordinators in CCS (MDT Co-ordinators)

3 Rapid Response

4 EOL: Cancer & Palliative Care

5 FallsPrevention: Co-ordinator in CCS

6 Intermediate Care

7 Joint Commissioning: Meet and Greet Service for Carers

8 Care Act Reforms

9 Rehabilitation & support for the Discharge Team

9 Development of GP cluster model - care management

9 Re-ablement Team Restructure to clusters

9 Reablement: Stepdown reablement flat

9 Reablement: Reablement Team (to better support seven day discharges)

BalanceIncome Expenditure£0£0£0

<< Link to summary sheetRunning Balances

DFGMinimum CCG ContributioniBCF

£1,417,554£13,888,448

£6,472,833

£1,417,554£13,888,448

£6,472,833

£0£0Winter Pressures Grant £788,125£788,125

£0£22,566,960

£6,344,639

£0

£0

£3,946,703

£6,344,639

Required SpendNHS Commissioned Out of Hospital spend from the minimum CCG allocationAdult Social Care services spend from the minimum CCG allocations

Minimum Required Spend Planned Spend Under Spend

Better Care Fund 2019/20 Template6. Expenditure

ExpenditurePlanned Outputs Metric Impact

£0£0£0

£0

Luton

Additional LA ContributionAdditional CCG Contribution

Total


£3,946,703

£0£22,566,960

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10 Learning Disabilities - supporting adult social care

10 Mental Health - supporting adult social care

10 Older People - supporting adult social care

10 Care management - supporting adult social care

11 Joint Autism Strategy

10 DTOC: Social Care Staff in DART to facilitate hospital discharge

10 DTOC: Hospital Discharge Initiatives continuation

11 IPC: Dementia Advisors (Alzheimers Society)

12 Wellbeing: Community Based Prevention

12 Wellbeing: Wellbeing projects continuation

13 Joint Commissioning: Programme Costs

14 LD Project Manager Transforming Care

80 Disabled Facilities Grant (DFG)

15 Equipment and adaptations: Community Equipment Services


15 Telecare

15 Equipment and adaptations: Adaptations & Minor Works

16 Social Prescription

17 STEPS

18 AMP Support/Training

19 Falls Prevention: Falls Scheme

20 EOL: End of Life Schemes

21 Early Supported Discharge Strokes

22 BLMK Transforming Care PM (1/3 FTE) CCG

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999 BCF Contingency CCG

51 Energy Doctor in the Home (preventative Technology)

52 Enabling Change - Systems integration, technology website change and population management

53 Population Management and Self Care Project

54 Side by Side

55 Enhanced Health in Care Homes -> Over 65s/carehome

56 Direct payment/Social Work Resources to support in community

57 Integrated IAG model

58 Housing First

59 iBCF Programme Support, System Integration & Restorative Practice

60 Community Learning Disability Team (2 nurses)

61 Housing ATS Telehealth (overrun into April-June)

999 iBCF Contingency

62 Meeting ASC growing needs

63 Suporting the care provider market

71 Homecare

72 Short stay mental health

73 Reviewing staff

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^^ Link back up

Funding planned towards the implementation of Care Act related duties.Supporting people to sustain their role as carers and reduce the likelihood of crisis. Advice, advocacy, information, assessment, emotional and physical support, training, access to services to support wellbeing and improve independence. This also includes the implementation of the Care Act as a sub-type.Schemes that are based in the community and constitute a range of cross sector practitioners delivering collaborative services in the community typically at a neighbourhood level (eg: Integrated Neighbourhood Teams)The DFG is a means-tested capital grant to help meet the costs of adapting a property; supporting people to stay independent in their own homes.

Using technology in care processes to supportive self-management, maintenance of independence and more efficient and effective delivery of care. (eg. Telecare, Wellness services, Digital participation services).

DescriptionScheme TypeAssistive Technologies and Equipment

Care Act Implementation Related Duties

Carers Services

Community Based Schemes

DFG Related Schemes

Sub TypeTelecareWellness ServicesDigital Participation ServicesCommunity Based EquipmentOthDeprivation of Liberty Safeguards (DoLS)OtherCarer Advice and SupportRespite ServicesOther

AdaptationsOther

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Enablers for Integration

High Impact Change Model for Managing Transfer of Care

Home Care or Domiciliary Care

Housing Related Schemes

Schemes that build and develop the enabling foundations of health and social care integration encompassing a wide range of potential areas including technology, workforce, market development (Voluntary Sector Business Development: Funding the business development and preparedness of local voluntary sector into provider Alliances/ Collaboratives) and programme management related schemes. Joint commissioning infrastructure includes any personnel or teams that enable joint commissioning. Schemes could be focused on Data Integration, System IT Interoperability, Programme management, Research and evaluation, Supporting the Care Market, Workforce development, Community asset mapping, New governance arrangements, Voluntary Sector Development, Employment services, J i t i i i i f t t t thThe eight changes or approaches identified as having a high impact on supporting timely and effective discharge through joint working across the social and health system. The Hospital to Home Transfer Protocol or the 'Red Bag' scheme, while not in the HICM as such, is included in this section.

A range of services that aim to help people live in their own homes through the provision of domiciliary care including personal care, domestic tasks, shopping, home maintenance and social activities. Home care can link with other services in the community, such as supported housing, community health services and voluntary sector services.

This covers expenditure on housing and housing-related services other than adaptations; eg: supported housing units.

Chg 1. Early Discharge PlanningChg 2. Systems to Monitor Patient FlowChg 3. Multi-Disciplinary/Multi-Agency Discharge TeamsChg 4. Home First / Discharge to AccessChg 5. Seven-Day ServicesChg 6. Trusted AssessorsChg 7. Focus on ChoiceChg 8. Enhancing Health in Care HomesOther - 'Red Bag' schemeOther approaches

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Short-term intervention to preserve the independence of people who might otherwise face unnecessarily prolonged hospital stays or avoidable admission to hospital or residential care. The care is person-centred and often delivered by a combination of professional groups. Four service models of intermediate care are: bed-based intermediate care, crisis or rapid response (including falls), home-based intermediate care, and reablement or rehabilitation. Home-based intermediate care is covered in Scheme-A and the other three models are available on the sub-types.

Intermediate Care Services

Care navigation services help people find their way to appropriate services and support and consequently support self-management. Also, the assistance offered to people in navigating through the complex health and social care systems (across primary care, community and voluntary services and social care) to overcome barriers in accessing the most appropriate care and support. Multi-agency teams typically provide these services which can be online or face to face care navigators for frail elderly, or dementia navigators etc. This includes approaches like Single Point of Access (SPoA) and linking people to community assets.Integrated care planning constitutes a co-ordinated, person centred and proactive case management approach to conduct joint assessments of care needs and develop integrated care plans typically carried out by professionals as part of a multi-disciplinary, multi-agency teams. Note: For Multi-Disciplinary Discharge Teams and the HICM for managing discharges, please select HICM as scheme type and the relevant sub-type. Where the planned unit of care delivery and funding is in the form of Integrated care packages and needs to be expressed in such a manner please select the appropriate sub type alongside

Integrated Care Planning and Navigation Care CoordinationSingle Point of AccessCare Planning, Assessment and ReviewOther

Bed Based - Step Up/DownRapid / Crisis ResponseReablement/Rehabilitation ServicesOther

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^^ Link back up

Residential Placements

Personalised Budgeting and Commissioning


Various person centred approaches to commissioning and budgeting.

Schemes specifically designed to ensure that a person can continue to live at home, through the provision of health related support at home often complemented with support for home care needs or mental health needs. This could include promoting self-management/expert patient, establishment of ‘home ward’ for intensive period or to deliver support over the longer term to maintain independence or offer end of life care for people. Intermediate care services provide shorter term support and care interventions as opposed to the ongoing support provided in this scheme type.

Services or schemes where the population or identified high-risk groups are empowered and activated to live well in the holistic sense thereby helping prevent people from entering the care system in the first place. These are essentially upstream prevention initiatives to promote independence and well being.Residential placements provide accommodation for people with learning or physical disabilities, mental health difficulties or with sight or hearing loss, who need more intensive or specialised support than can be provided at home.

Prevention / Early Intervention

Where the scheme is not adequately represented by the above scheme types, please outline the objectives and services planned for the scheme in a short description in the comments column.

Other

Personal Health BudgetsIntegrated Personalised CommissioningDirect PaymentsOther

Social PrescribingRisk StratificationChoice PolicyOther

Supported LivingLearning DisabilityExtra CareCare HomeNursing HomeOther

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Please enter current position of maturity

Please enter the maturity level planned to be reached by March 2020

If the planned maturity level for 2019/20 is below established, please state reasons behind that?

Chg 1Early discharge planning

Exemplary Exemplary

Chg 2Systems to monitor patient flow Exemplary Exemplary

Chg 3Multi-disciplinary/Multi-agency discharge teams Exemplary Exemplary

Chg 4Home first / discharge to assess Mature Exemplary

Chg 5Seven-day service

Exemplary Exemplary

Chg 6Trusted assessors

Established Mature

Chg 7Focus on choice

Exemplary Exemplary

Chg 8Enhancing health in care homes Mature Mature

Better Care Fund 2019/20 Template7. High Impact Change Model

Five out of the eight High Impact Change Models for Managing Transfers of Care have now matured to exemplary. Three High Impact Change Models are currently assigned established or mature status, HomeFirst/Discharge to Assess, Trusted Assessor and Enhanced Health in Care homes.

Home First/Discharge to Assess has reached maturity and is projected to meet the exemplary status by March 2020. ***** MORE TO ADD (Nicky Poulain/Amanda Flower)*****

Luton

- The changes that you are looking to embed further - including any changes in the context of commitments to reablement and Enhanced Health in Care Homes in the NHS Long-Term Plan

Explain your priorities for embedding elements of the High Impact Change Model for Managing Transfers of Care locally, including:- Current performance issues to be addressed

- Anticipated improvements from this work

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Total number of specific acute non-elective spells per 100,000 population

Please set out the overall plan in the HWB area for reducing Non-Elective Admissions, including any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric.

19/20 Plan

3.9

Please set out the overall plan in the HWB area for reducing Delayed Transfers of Care to meet expectations set for your area. This should include any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric. Include in this, your agreed plan for using the Winter Pressures grant funding to support the local health and care system to manage demand pressures on the NHS, with particular reference to seasonal winter pressures.


Delayed Transfers of Care per day (daily delays) from hospital (aged 18+)

Luton CCG has a suite of Quality, Innovation, Productivity and Prevention (QIPP) schemes to improve care and reduce hospital admission where care can be delivered more effectivity elsewhere. Initiatives to deliver reductions in Non-Elective admissions in 19/20 include redesigned care pathways for patients:• who are over 65, frail with a previous hospital admission• who may need an ambulance and can be conveyed to an alternative service hospital via ambulance • who’s General Practitioner make request for immediate care resulting in a hospital

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Overview NarrativeThe 2018 -2019 nationally set ambition for DToC in Luton was particularly challenging. The target was set at a total of 171 delayed bed days per month and will remain at his figure during 2019-2020. The Luton discharge protocol and outcomes are classified as exemplary, the Luton and Dunstable hospital Multi-disciplinary Discharge team expect ot maintain this position through out 2019-2020.

Currently the Luton and Dunstable Hospital have Situation Reporting on every ward Monday Wednesday and Friday. These sessions are carried out by senior staff from the Trust and the wards are encouraged to discuss any patient’s that are complex and may cause a delayed discharge. Tuesdays and Thursdays there is a whole system Patient Tracking session where all stakeholders are represented this also allows discussion to

8.1 Non-Elective Admissions

Please note that the plan figure for Greater Manchester has been combined, for HWBs in Greater Manchester please comment on individuals HWBs rather than Greater Manchester as a whole.

Better Care Fund 2019/20 Template8. Metrics

8.2 Delayed Transfers of Care

Please note that due to the merger of Bournemouth, Christchurch and Poole to a new Local Authority will mean that planning information from 2018/19 will not reflect the present geographies.

Overview Narrative19/20 Plan

Collection of the NEA metric plans via this template is not required as the BCF NEA metric plans are based on the NEA CCG Operating plans submitted via SDCS.

Plans are yet to be finalised and signed-off so are subject to change; for the latest version of the NEA CCG operating plans at your HWB footprint please contact your local Better Care Manager (BCM) in the first instance or write in to the support inbox:[email protected]

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18/19 Plan 19/20 Plan

Annual Rate639 639

Numerator170 175

Denominator26,620 27,396

18/19 Plan 19/20 Plan

Annual (%)82.5% 82.5%

Numerator132 132

Denominator160 160

Please note that due to the merger of the Bournemouth, Christchurch and Poole Local Authorities, this will mean that planning information from 2018/19 will not reflect the present geographies.

Please set out the overall plan in the HWB area for reducing rates of admission to residential and nursing homes for people over the age of 65, including any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric.

Please set out the overall plan in the HWB area for increasing the proportion of older people who are still at home 91 days after discharge from hospital into reablement/rehabilitation, including any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric.

The national ambitions for reablement will remain the same as 2018-2019. Lutons Reablement service provide short term support for individuals who have experienced an accident, medical crisis or change in circumstance with the primary goal to make them independent again. Reablement can last up to 6 weeks and supports

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Comments

8.4 Reablement



Long-term support needs of older people (age 65 and over) met by admission to residential and nursing care homes, per 100,000 population (aged 65+) population projections are based on a calendar year using the 2016 based Sub-National Population Projections for Local Authorities in England;

CommentsThe 2019-2020 target and expectation for the number of persons admitted into residentail and nursing care currently remains the same as set in the previous year. Adult Social Care have implemented a Pathways Model in line with Care Act 2014. We now work closely with our health colleagues from CCG and CCS to ensure we

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8.3 Residential Admissions

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Theme Code

Planning Requirement Key considerations for meeting the planning requirementThese are the Key Lines of Enquiry (KLOEs) underpinning the Planning Requirements (PR)

Please confirm whether your BCF plan meets the Planning Requirement?

Please note any supporting documents referred to and relevant page numbers to assist the assurers

Where the Planning requirement is not met, please note the actions in place towards meeting the requirement

Where the Planning requirement is not met, please note the anticipated timeframe for meeting it

PR1 A jointly developed and agreed plan that all parties sign up to

Has a plan; jointly developed and agreed between CCG(s) and LA; been submitted?Has the HWB approved the plan/delegated approval pending its next meeting?Have local partners, including providers, VCS representatives and local authority service leads (including housing and DFG leads) been involved in the development of the plan?Do the governance arrangements described support collaboration and integrated care?Where the strategic narrative section of the plan has been agreed across more than one HWB, have individual income, expenditure, metric and HICM sections of the plan been submitted for each HWB concerned?

Yes

PR2 A clear narrative for the integration of health and social care

Is there a narrative plan for the HWB that describes the approach to delivering integrated health and social care that covers:- Person centred care, including approaches to delivering joint assessments, promoting choice, independence and personalised care?- A clear approach at HWB level for integrating services that supports the overall approach to integrated care and confirmation that the approach supports delivery at the interface between health and social care?- A description of how the local BCF plan and other integration plans e.g. STP/ICSs align?- Is there a description of how the plan will contribute to reducing health inequalities (as per section 4 of the Health and Social Care Act) and to reduce inequalities for people with protected characteristics under the Equality Act 2010? This should include confirmation that equality impacts of the local BCF plan have been considered, a description of local priorities related to health inequality and equality that the BCF plan will contribute to addressing.Has the plan summarised any changes from the previous planning period? And noted (where appropriate) any lessons learnt?

Yes

1. Luton Single system Operating Plan2.Health and Wellbeing Strategy3. Luton Joint Strategic Needs Assessment 4. Luton 5 year At Place Plan is underway5. Out of Hospital Plan6. Transformation Board ToR7. JSCG ToR8. HWB ToR9. Luton Borough Council 2040

PR3 A strategic, joined up plan for DFG spending

Is there confirmation that use of DFG has been agreed with housing authorities?Does the narrative set out a strategic approach to using housing support, including use of DFG funding that supports independence at home.In two tier areas, has: - Agreement been reached on the amount of DFG funding to be passed to district councils to cover statutory Disabled Facilities Grants? or - The funding been passed in its entirety to district councils?

Yes


PR4 A demonstration of how the area will maintain the level of spending on social care services from the CCG minimum contribution to the fund in line with the uplift in the overall contribution

Does the total spend from the CCG minimum contribution on social care match or exceed the minimum required contribution (auto-validated on the planning template)?

Yes


PR5 Has the area committed to spend at equal to or above the minimum allocation for NHS commissioned out of hospital services from the CCG minimum BCF contribution?

Does the total spend from the CCG minimum contribution on non-acute, NHS commissioned care exceed the minimum ringfence (auto-validated on the planning template)?

Yes


PR6 Is there a plan for implementing the High Impact Change Model for managing transfers of care?

Does the BCF plan demonstrate a continued plan in place for implementing the High Impact Change Model for Managing Transfers of Care?Has the area confirmed the current level of implementation and the planned level at March 2020 for all eight changes?Is there an accompanying overall narrative setting out the priorities and approach for ongoing implementation of the HICM?Does the level of ambition set out for implementing the HICM changes correspond to performance challenges in the system?If the current level of implementation is below established for any of the HICM changes, has the plan included a clear explanation and set of actions towards establishing the change as soon as possible in 2019-20?

Yes


Better Care Fund 2019/20 Template9. Confirmation of Planning Requirements

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PR7 Is there a confirmation that the components of the Better Care Fund pool that are earmarked for a purpose are being planned to be used for that purpose?

Have the planned schemes been assigned to the metrics they are aiming to make an impact on?Expenditure plans for each element of the BCF pool match the funding inputs? (auto-validated)Is there confirmation that the use of grant funding is in line with the relevant grant conditions? (tick-box)Is there an agreed plan for use of the Winter Pressures grant that sets out how the money will be used to address expected demand pressures on the Health system over Winter?Has funding for the following from the CCG contribution been identified for the area?- Implementation of Care Act duties?- Funding dedicated to carer-specific support?- Reablement?

Yes

PR8 Indication of outputs for specified scheme types

Has the area set out the outputs corresponding to the planned scheme types (Note that this is only for where any of the specified set of scheme types requiring outputs are planned)? (auto-validated)

Yes

Metrics

PR9 Does the plan set stretching metrics and are there clear and ambitious plans for delivering these?

Is there a clear narrative for each metric describing the approach locally to meeting the ambition set for that metric?Is there a proportionate range of scheme types and spend included in the expenditure section of the plan to support delivery of the metric ambitions for each of the metrics?Do the narrative plans for each metric set out clear and ambitious approaches to delivering improvements?Have stretching metrics been agreed locally for:- Metric 2: Long term admission to residential and nursing care homes- Metric 3: Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement

Yes


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CCG to Health and Well-Being Board Mapping for 2019/20

HWB Code LA Name CCG Code CCG Name % CCG in HWB % HWB in CCGE09000002 Barking and Dagenham 07L NHS Barking and Dagenham CCG 90.7% 87.4%E09000002 Barking and Dagenham 08F NHS Havering CCG 6.9% 8.3%E09000002 Barking and Dagenham 08M NHS Newham CCG 0.4% 0.6%E09000002 Barking and Dagenham 08N NHS Redbridge CCG 2.5% 3.5%E09000002 Barking and Dagenham 08W NHS Waltham Forest CCG 0.1% 0.1%E09000003 Barnet 07M NHS Barnet CCG 91.1% 92.1%E09000003 Barnet 07P NHS Brent CCG 2.0% 1.8%E09000003 Barnet 07R NHS Camden CCG 1.0% 0.7%E09000003 Barnet 09A NHS Central London (Westminster) CCG 0.2% 0.1%E09000003 Barnet 07X NHS Enfield CCG 3.0% 2.4%E09000003 Barnet 08C NHS Hammersmith and Fulham CCG 0.3% 0.2%E09000003 Barnet 08D NHS Haringey CCG 2.2% 1.6%E09000003 Barnet 08E NHS Harrow CCG 1.2% 0.8%E09000003 Barnet 06N NHS Herts Valleys CCG 0.0% 0.1%E09000003 Barnet 08H NHS Islington CCG 0.2% 0.1%E09000003 Barnet 08Y NHS West London (K&C & QPP) CCG 0.2% 0.1%E08000016 Barnsley 02P NHS Barnsley CCG 94.6% 98.1%E08000016 Barnsley 02X NHS Doncaster CCG 0.3% 0.4%E08000016 Barnsley 03A NHS Greater Huddersfield CCG 0.2% 0.2%E08000016 Barnsley 03L NHS Rotherham CCG 0.3% 0.3%E08000016 Barnsley 03N NHS Sheffield CCG 0.2% 0.4%E08000016 Barnsley 03R NHS Wakefield CCG 0.4% 0.6%E06000022 Bath and North East Somerset 11E NHS Bath and North East Somerset CCG 93.5% 98.3%E06000022 Bath and North East Somerset 15C NHS Bristol, North Somerset and South Gloucestershire CCG 0.2% 0.9%E06000022 Bath and North East Somerset 11X NHS Somerset CCG 0.2% 0.5%E06000022 Bath and North East Somerset 99N NHS Wiltshire CCG 0.1% 0.3%E06000055 Bedford 06F NHS Bedfordshire CCG 37.7% 97.4%E06000055 Bedford 06H NHS Cambridgeshire and Peterborough CCG 0.4% 1.9%E06000055 Bedford 04G NHS Nene CCG 0.2% 0.6%E09000004 Bexley 07N NHS Bexley CCG 93.4% 89.8%E09000004 Bexley 07Q NHS Bromley CCG 0.1% 0.1%E09000004 Bexley 09J NHS Dartford, Gravesham and Swanley CCG 1.4% 1.5%E09000004 Bexley 08A NHS Greenwich CCG 7.2% 8.4%E09000004 Bexley 08L NHS Lewisham CCG 0.1% 0.1%E08000025 Birmingham 15E NHS Birmingham and Solihull CCG 78.4% 81.7%E08000025 Birmingham 05C NHS Dudley CCG 0.2% 0.0%E08000025 Birmingham 05J NHS Redditch and Bromsgrove CCG 3.1% 0.4%E08000025 Birmingham 05L NHS Sandwell and West Birmingham CCG 39.2% 17.8%E08000025 Birmingham 05Y NHS Walsall CCG 0.5% 0.1%E06000008 Blackburn with Darwen 00Q NHS Blackburn with Darwen CCG 88.9% 95.8%E06000008 Blackburn with Darwen 00T NHS Bolton CCG 1.2% 2.3%E06000008 Blackburn with Darwen 00V NHS Bury CCG 0.2% 0.2%E06000008 Blackburn with Darwen 01A NHS East Lancashire CCG 0.7% 1.7%E06000009 Blackpool 00R NHS Blackpool CCG 86.4% 97.6%E06000009 Blackpool 02M NHS Fylde & Wyre CCG 2.1% 2.4%E08000001 Bolton 00T NHS Bolton CCG 97.3% 97.5%E08000001 Bolton 00V NHS Bury CCG 1.5% 1.0%E08000001 Bolton 00X NHS Chorley and South Ribble CCG 0.2% 0.1%E08000001 Bolton 01G NHS Salford CCG 0.6% 0.5%E08000001 Bolton 02H NHS Wigan Borough CCG 0.8% 0.9%E06000058 Bournemouth, Christchurch and Poole 11J NHS Dorset CCG 52.4% 99.7%E06000058 Bournemouth, Christchurch and Poole 11A NHS West Hampshire CCG 0.2% 0.3%E06000036 Bracknell Forest 15A NHS Berkshire West CCG 0.5% 2.0%E06000036 Bracknell Forest 15D NHS East Berkshire CCG 26.1% 96.9%E06000036 Bracknell Forest 99M NHS North East Hampshire and Farnham CCG 0.6% 1.0%E06000036 Bracknell Forest 10C NHS Surrey Heath CCG 0.2% 0.1%E08000032 Bradford 02N NHS Airedale, Wharfdale and Craven CCG 67.2% 18.4%E08000032 Bradford 02W NHS Bradford City CCG 98.9% 23.9%E08000032 Bradford 02R NHS Bradford Districts CCG 98.0% 56.3%E08000032 Bradford 02T NHS Calderdale CCG 0.2% 0.0%E08000032 Bradford 15F NHS Leeds CCG 0.9% 1.4%E08000032 Bradford 03J NHS North Kirklees CCG 0.2% 0.0%E09000005 Brent 07M NHS Barnet CCG 2.3% 2.4%E09000005 Brent 07P NHS Brent CCG 89.7% 86.4%E09000005 Brent 07R NHS Camden CCG 3.9% 2.8%E09000005 Brent 09A NHS Central London (Westminster) CCG 1.3% 0.7%E09000005 Brent 07W NHS Ealing CCG 0.5% 0.6%E09000005 Brent 08C NHS Hammersmith and Fulham CCG 0.6% 0.4%E09000005 Brent 08E NHS Harrow CCG 5.9% 4.0%E09000005 Brent 08Y NHS West London (K&C & QPP) CCG 4.3% 2.7%E06000043 Brighton and Hove 09D NHS Brighton and Hove CCG 97.9% 99.7%E06000043 Brighton and Hove 09G NHS Coastal West Sussex CCG 0.1% 0.2%E06000043 Brighton and Hove 99K NHS High Weald Lewes Havens CCG 0.3% 0.1%E06000023 Bristol, City of 11E NHS Bath and North East Somerset CCG 0.1% 0.0%E06000023 Bristol, City of 15C NHS Bristol, North Somerset and South Gloucestershire CCG 49.3% 100.0%E09000006 Bromley 07N NHS Bexley CCG 0.2% 0.1%E09000006 Bromley 07Q NHS Bromley CCG 94.6% 95.1%E09000006 Bromley 07V NHS Croydon CCG 1.2% 1.4%E09000006 Bromley 08A NHS Greenwich CCG 1.4% 1.2%E09000006 Bromley 08C NHS Hammersmith and Fulham CCG 0.1% 0.0%E09000006 Bromley 08K NHS Lambeth CCG 0.1% 0.2%E09000006 Bromley 08L NHS Lewisham CCG 1.9% 1.8%E09000006 Bromley 99J NHS West Kent CCG 0.1% 0.2%

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E10000002 Buckinghamshire 06F NHS Bedfordshire CCG 0.6% 0.5%E10000002 Buckinghamshire 14Y NHS Buckinghamshire CCG 94.4% 94.9%E10000002 Buckinghamshire 15D NHS East Berkshire CCG 1.4% 1.2%E10000002 Buckinghamshire 06N NHS Herts Valleys CCG 1.2% 1.4%E10000002 Buckinghamshire 08G NHS Hillingdon CCG 0.7% 0.4%E10000002 Buckinghamshire 04F NHS Milton Keynes CCG 1.3% 0.7%E10000002 Buckinghamshire 04G NHS Nene CCG 0.1% 0.2%E10000002 Buckinghamshire 10Q NHS Oxfordshire CCG 0.6% 0.7%E08000002 Bury 00T NHS Bolton CCG 0.8% 1.2%E08000002 Bury 00V NHS Bury CCG 94.0% 94.3%E08000002 Bury 01A NHS East Lancashire CCG 0.0% 0.2%E08000002 Bury 01D NHS Heywood, Middleton and Rochdale CCG 0.4% 0.5%E08000002 Bury 14L NHS Manchester CCG 0.6% 2.0%E08000002 Bury 01G NHS Salford CCG 1.4% 1.9%E08000033 Calderdale 02R NHS Bradford Districts CCG 0.4% 0.6%E08000033 Calderdale 02T NHS Calderdale CCG 98.4% 98.9%E08000033 Calderdale 03A NHS Greater Huddersfield CCG 0.3% 0.3%E08000033 Calderdale 01D NHS Heywood, Middleton and Rochdale CCG 0.1% 0.1%E10000003 Cambridgeshire 06F NHS Bedfordshire CCG 1.1% 0.7%E10000003 Cambridgeshire 06H NHS Cambridgeshire and Peterborough CCG 71.8% 96.7%E10000003 Cambridgeshire 06K NHS East and North Hertfordshire CCG 0.8% 0.7%E10000003 Cambridgeshire 99D NHS South Lincolnshire CCG 0.3% 0.0%E10000003 Cambridgeshire 07H NHS West Essex CCG 0.2% 0.1%E10000003 Cambridgeshire 07J NHS West Norfolk CCG 1.6% 0.4%E10000003 Cambridgeshire 07K NHS West Suffolk CCG 4.0% 1.4%E09000007 Camden 07M NHS Barnet CCG 0.2% 0.3%E09000007 Camden 07P NHS Brent CCG 1.3% 1.9%E09000007 Camden 07R NHS Camden CCG 83.9% 88.9%E09000007 Camden 09A NHS Central London (Westminster) CCG 5.6% 4.8%E09000007 Camden 08C NHS Hammersmith and Fulham CCG 0.4% 0.3%E09000007 Camden 08D NHS Haringey CCG 0.5% 0.6%E09000007 Camden 08H NHS Islington CCG 3.2% 3.0%E09000007 Camden 08Y NHS West London (K&C & QPP) CCG 0.3% 0.2%E06000056 Central Bedfordshire 06F NHS Bedfordshire CCG 56.6% 95.0%E06000056 Central Bedfordshire 14Y NHS Buckinghamshire CCG 0.8% 1.5%E06000056 Central Bedfordshire 06K NHS East and North Hertfordshire CCG 0.3% 0.6%E06000056 Central Bedfordshire 06N NHS Herts Valleys CCG 0.4% 0.9%E06000056 Central Bedfordshire 06P NHS Luton CCG 2.3% 1.9%E06000056 Central Bedfordshire 04F NHS Milton Keynes CCG 0.1% 0.1%E06000049 Cheshire East 15M NHS Derby and Derbyshire CCG 0.1% 0.3%E06000049 Cheshire East 01C NHS Eastern Cheshire CCG 96.4% 50.2%E06000049 Cheshire East 05G NHS North Staffordshire CCG 1.1% 0.6%E06000049 Cheshire East 01R NHS South Cheshire CCG 98.6% 45.8%E06000049 Cheshire East 01W NHS Stockport CCG 1.6% 1.2%E06000049 Cheshire East 02A NHS Trafford CCG 0.2% 0.1%E06000049 Cheshire East 02D NHS Vale Royal CCG 0.6% 0.2%E06000049 Cheshire East 02E NHS Warrington CCG 0.7% 0.4%E06000049 Cheshire East 02F NHS West Cheshire CCG 1.9% 1.2%E06000050 Cheshire West and Chester 01C NHS Eastern Cheshire CCG 1.2% 0.7%E06000050 Cheshire West and Chester 01F NHS Halton CCG 0.2% 0.0%E06000050 Cheshire West and Chester 01R NHS South Cheshire CCG 0.5% 0.2%E06000050 Cheshire West and Chester 02D NHS Vale Royal CCG 99.4% 29.5%E06000050 Cheshire West and Chester 02E NHS Warrington CCG 0.4% 0.3%E06000050 Cheshire West and Chester 02F NHS West Cheshire CCG 96.9% 69.1%E06000050 Cheshire West and Chester 12F NHS Wirral CCG 0.3% 0.3%E09000001 City of London 07R NHS Camden CCG 0.2% 7.0%E09000001 City of London 09A NHS Central London (Westminster) CCG 0.1% 2.5%E09000001 City of London 07T NHS City and Hackney CCG 1.8% 70.4%E09000001 City of London 08C NHS Hammersmith and Fulham CCG 0.0% 1.2%E09000001 City of London 08H NHS Islington CCG 0.1% 3.6%E09000001 City of London 08V NHS Tower Hamlets CCG 0.4% 15.0%E09000001 City of London 08Y NHS West London (K&C & QPP) CCG 0.0% 0.2%E06000052 Cornwall & Scilly 15N NHS Devon CCG 0.3% 0.6%E06000052 Cornwall & Scilly 11N NHS Kernow CCG 99.7% 99.4%E06000047 County Durham 00D NHS Durham Dales, Easington and Sedgefield CCG 97.0% 52.4%E06000047 County Durham 03D NHS Hambleton, Richmondshire and Whitby CCG 0.1% 0.0%E06000047 County Durham 00K NHS Hartlepool and Stockton-On-Tees CCG 0.1% 0.0%E06000047 County Durham 13T NHS Newcastle Gateshead CCG 0.7% 0.7%E06000047 County Durham 00J NHS North Durham CCG 96.7% 46.3%E06000047 County Durham 00P NHS Sunderland CCG 1.2% 0.6%E08000026 Coventry 05A NHS Coventry and Rugby CCG 74.5% 99.8%E08000026 Coventry 05H NHS Warwickshire North CCG 0.4% 0.2%E09000008 Croydon 07Q NHS Bromley CCG 1.6% 1.3%E09000008 Croydon 07V NHS Croydon CCG 95.3% 93.2%E09000008 Croydon 09L NHS East Surrey CCG 2.9% 1.3%E09000008 Croydon 08C NHS Hammersmith and Fulham CCG 0.2% 0.0%E09000008 Croydon 08K NHS Lambeth CCG 3.0% 3.0%E09000008 Croydon 08R NHS Merton CCG 0.8% 0.4%E09000008 Croydon 08T NHS Sutton CCG 0.8% 0.4%E09000008 Croydon 08X NHS Wandsworth CCG 0.5% 0.5%

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E10000006 Cumbria 01K NHS Morecambe Bay CCG 54.0% 36.6%E10000006 Cumbria 01H NHS North Cumbria CCG 99.9% 63.4%E06000005 Darlington 00C NHS Darlington CCG 98.2% 96.1%E06000005 Darlington 00D NHS Durham Dales, Easington and Sedgefield CCG 1.2% 3.2%E06000005 Darlington 03D NHS Hambleton, Richmondshire and Whitby CCG 0.1% 0.2%E06000005 Darlington 00K NHS Hartlepool and Stockton-On-Tees CCG 0.2% 0.6%E06000015 Derby 15M NHS Derby and Derbyshire CCG 26.5% 100.0%E10000007 Derbyshire 02Q NHS Bassetlaw CCG 0.2% 0.0%E10000007 Derbyshire 15M NHS Derby and Derbyshire CCG 70.9% 92.6%E10000007 Derbyshire 05D NHS East Staffordshire CCG 7.9% 1.4%E10000007 Derbyshire 01C NHS Eastern Cheshire CCG 0.3% 0.0%E10000007 Derbyshire 04E NHS Mansfield and Ashfield CCG 2.1% 0.5%E10000007 Derbyshire 04L NHS Nottingham North and East CCG 0.3% 0.0%E10000007 Derbyshire 04M NHS Nottingham West CCG 5.1% 0.6%E10000007 Derbyshire 03N NHS Sheffield CCG 0.5% 0.4%E10000007 Derbyshire 01W NHS Stockport CCG 0.1% 0.0%E10000007 Derbyshire 01Y NHS Tameside and Glossop CCG 13.9% 4.3%E10000007 Derbyshire 04V NHS West Leicestershire CCG 0.5% 0.2%E10000008 Devon 15N NHS Devon CCG 65.7% 99.2%E10000008 Devon 11J NHS Dorset CCG 0.3% 0.3%E10000008 Devon 11N NHS Kernow CCG 0.3% 0.2%E10000008 Devon 11X NHS Somerset CCG 0.4% 0.3%E08000017 Doncaster 02P NHS Barnsley CCG 0.3% 0.3%E08000017 Doncaster 02Q NHS Bassetlaw CCG 1.5% 0.6%E08000017 Doncaster 02X NHS Doncaster CCG 96.8% 97.8%E08000017 Doncaster 03L NHS Rotherham CCG 1.5% 1.2%E08000017 Doncaster 03R NHS Wakefield CCG 0.1% 0.2%E06000059 Dorset 11J NHS Dorset CCG 46.0% 95.6%E06000059 Dorset 11X NHS Somerset CCG 0.6% 0.9%E06000059 Dorset 11A NHS West Hampshire CCG 1.7% 2.5%E06000059 Dorset 99N NHS Wiltshire CCG 0.7% 1.0%E08000027 Dudley 15E NHS Birmingham and Solihull CCG 0.1% 0.6%E08000027 Dudley 05C NHS Dudley CCG 93.3% 90.7%E08000027 Dudley 05L NHS Sandwell and West Birmingham CCG 3.9% 6.9%E08000027 Dudley 06A NHS Wolverhampton CCG 1.8% 1.5%E08000027 Dudley 06D NHS Wyre Forest CCG 0.8% 0.3%E09000009 Ealing 07P NHS Brent CCG 1.8% 1.6%E09000009 Ealing 09A NHS Central London (Westminster) CCG 0.2% 0.1%E09000009 Ealing 07W NHS Ealing CCG 86.9% 90.4%E09000009 Ealing 08C NHS Hammersmith and Fulham CCG 5.5% 3.1%E09000009 Ealing 08E NHS Harrow CCG 0.4% 0.3%E09000009 Ealing 08G NHS Hillingdon CCG 0.7% 0.5%E09000009 Ealing 07Y NHS Hounslow CCG 4.7% 3.5%E09000009 Ealing 08Y NHS West London (K&C & QPP) CCG 0.7% 0.4%E06000011 East Riding of Yorkshire 02Y NHS East Riding of Yorkshire CCG 97.3% 85.1%E06000011 East Riding of Yorkshire 03F NHS Hull CCG 9.2% 7.9%E06000011 East Riding of Yorkshire 03M NHS Scarborough and Ryedale CCG 0.7% 0.2%E06000011 East Riding of Yorkshire 03Q NHS Vale of York CCG 6.6% 6.8%E10000011 East Sussex 09D NHS Brighton and Hove CCG 1.0% 0.6%E10000011 East Sussex 09F NHS Eastbourne, Hailsham and Seaford CCG 100.0% 34.7%E10000011 East Sussex 09P NHS Hastings and Rother CCG 99.7% 33.3%E10000011 East Sussex 99K NHS High Weald Lewes Havens CCG 98.1% 29.6%E10000011 East Sussex 09X NHS Horsham and Mid Sussex CCG 2.8% 1.2%E10000011 East Sussex 99J NHS West Kent CCG 0.8% 0.7%E09000010 Enfield 07M NHS Barnet CCG 1.0% 1.2%E09000010 Enfield 07T NHS City and Hackney CCG 0.1% 0.1%E09000010 Enfield 06K NHS East and North Hertfordshire CCG 0.3% 0.6%E09000010 Enfield 07X NHS Enfield CCG 95.2% 90.9%E09000010 Enfield 08C NHS Hammersmith and Fulham CCG 0.1% 0.0%E09000010 Enfield 08D NHS Haringey CCG 7.7% 6.9%E09000010 Enfield 06N NHS Herts Valleys CCG 0.1% 0.2%E09000010 Enfield 08H NHS Islington CCG 0.2% 0.1%E10000012 Essex 07L NHS Barking and Dagenham CCG 0.1% 0.0%E10000012 Essex 99E NHS Basildon and Brentwood CCG 99.8% 18.2%E10000012 Essex 06H NHS Cambridgeshire and Peterborough CCG 0.1% 0.0%E10000012 Essex 99F NHS Castle Point and Rochford CCG 95.2% 11.5%E10000012 Essex 06K NHS East and North Hertfordshire CCG 1.6% 0.6%E10000012 Essex 08F NHS Havering CCG 0.3% 0.0%E10000012 Essex 06L NHS Ipswich and East Suffolk CCG 0.2% 0.0%E10000012 Essex 06Q NHS Mid Essex CCG 100.0% 25.5%E10000012 Essex 06T NHS North East Essex CCG 98.6% 22.7%E10000012 Essex 08N NHS Redbridge CCG 2.9% 0.6%E10000012 Essex 99G NHS Southend CCG 3.3% 0.4%E10000012 Essex 07G NHS Thurrock CCG 1.4% 0.2%E10000012 Essex 08W NHS Waltham Forest CCG 0.5% 0.1%E10000012 Essex 07H NHS West Essex CCG 97.1% 19.8%E10000012 Essex 07K NHS West Suffolk CCG 2.3% 0.4%

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E08000037 Gateshead 13T NHS Newcastle Gateshead CCG 38.5% 97.7%E08000037 Gateshead 00J NHS North Durham CCG 0.9% 1.2%E08000037 Gateshead 00L NHS Northumberland CCG 0.5% 0.8%E08000037 Gateshead 00N NHS South Tyneside CCG 0.3% 0.2%E08000037 Gateshead 00P NHS Sunderland CCG 0.0% 0.1%E10000013 Gloucestershire 15C NHS Bristol, North Somerset and South Gloucestershire CCG 0.1% 0.1%E10000013 Gloucestershire 11M NHS Gloucestershire CCG 97.6% 98.6%E10000013 Gloucestershire 05F NHS Herefordshire CCG 0.5% 0.1%E10000013 Gloucestershire 10Q NHS Oxfordshire CCG 0.2% 0.2%E10000013 Gloucestershire 05R NHS South Warwickshire CCG 0.6% 0.2%E10000013 Gloucestershire 05T NHS South Worcestershire CCG 1.1% 0.5%E10000013 Gloucestershire 99N NHS Wiltshire CCG 0.2% 0.2%E09000011 Greenwich 07N NHS Bexley CCG 5.1% 4.2%E09000011 Greenwich 07Q NHS Bromley CCG 1.1% 1.3%E09000011 Greenwich 08A NHS Greenwich CCG 89.2% 89.3%E09000011 Greenwich 08C NHS Hammersmith and Fulham CCG 0.2% 0.2%E09000011 Greenwich 08L NHS Lewisham CCG 4.4% 4.9%E09000011 Greenwich 08Q NHS Southwark CCG 0.1% 0.1%E09000012 Hackney 07R NHS Camden CCG 0.7% 0.7%E09000012 Hackney 09A NHS Central London (Westminster) CCG 0.2% 0.2%E09000012 Hackney 07T NHS City and Hackney CCG 90.2% 93.8%E09000012 Hackney 08C NHS Hammersmith and Fulham CCG 0.5% 0.4%E09000012 Hackney 08D NHS Haringey CCG 0.6% 0.7%E09000012 Hackney 08H NHS Islington CCG 4.6% 3.7%E09000012 Hackney 08V NHS Tower Hamlets CCG 0.5% 0.6%E06000006 Halton 01F NHS Halton CCG 98.2% 96.5%E06000006 Halton 01J NHS Knowsley CCG 0.2% 0.3%E06000006 Halton 99A NHS Liverpool CCG 0.3% 1.1%E06000006 Halton 02E NHS Warrington CCG 0.7% 1.1%E06000006 Halton 02F NHS West Cheshire CCG 0.6% 1.1%E09000013 Hammersmith and Fulham 07P NHS Brent CCG 0.3% 0.5%E09000013 Hammersmith and Fulham 07R NHS Camden CCG 0.1% 0.1%E09000013 Hammersmith and Fulham 09A NHS Central London (Westminster) CCG 2.5% 2.5%E09000013 Hammersmith and Fulham 07W NHS Ealing CCG 0.6% 1.1%E09000013 Hammersmith and Fulham 08C NHS Hammersmith and Fulham CCG 82.8% 87.6%E09000013 Hammersmith and Fulham 07Y NHS Hounslow CCG 0.5% 0.7%E09000013 Hammersmith and Fulham 08X NHS Wandsworth CCG 0.2% 0.3%E09000013 Hammersmith and Fulham 08Y NHS West London (K&C & QPP) CCG 6.5% 7.2%E10000014 Hampshire 15A NHS Berkshire West CCG 1.7% 0.6%E10000014 Hampshire 09G NHS Coastal West Sussex CCG 0.2% 0.1%E10000014 Hampshire 11J NHS Dorset CCG 0.5% 0.3%E10000014 Hampshire 15D NHS East Berkshire CCG 0.2% 0.0%E10000014 Hampshire 10K NHS Fareham and Gosport CCG 98.5% 14.3%E10000014 Hampshire 09N NHS Guildford and Waverley CCG 2.9% 0.5%E10000014 Hampshire 99M NHS North East Hampshire and Farnham CCG 76.5% 12.4%E10000014 Hampshire 10J NHS North Hampshire CCG 99.2% 15.9%E10000014 Hampshire 10R NHS Portsmouth CCG 4.4% 0.7%E10000014 Hampshire 10V NHS South Eastern Hampshire CCG 95.6% 14.6%E10000014 Hampshire 10X NHS Southampton CCG 5.1% 1.0%E10000014 Hampshire 10C NHS Surrey Heath CCG 0.8% 0.0%E10000014 Hampshire 11A NHS West Hampshire CCG 97.7% 39.1%E10000014 Hampshire 99N NHS Wiltshire CCG 1.3% 0.4%E09000014 Haringey 07M NHS Barnet CCG 1.0% 1.4%E09000014 Haringey 07R NHS Camden CCG 0.6% 0.6%E09000014 Haringey 09A NHS Central London (Westminster) CCG 0.1% 0.1%E09000014 Haringey 07T NHS City and Hackney CCG 3.1% 3.2%E09000014 Haringey 07X NHS Enfield CCG 1.3% 1.4%E09000014 Haringey 08C NHS Hammersmith and Fulham CCG 0.4% 0.3%E09000014 Haringey 08D NHS Haringey CCG 87.7% 91.0%E09000014 Haringey 08H NHS Islington CCG 2.5% 2.1%E09000015 Harrow 07M NHS Barnet CCG 4.3% 6.4%E09000015 Harrow 07P NHS Brent CCG 3.6% 4.8%E09000015 Harrow 07W NHS Ealing CCG 1.3% 2.1%E09000015 Harrow 08C NHS Hammersmith and Fulham CCG 0.1% 0.0%E09000015 Harrow 08E NHS Harrow CCG 89.7% 84.1%E09000015 Harrow 06N NHS Herts Valleys CCG 0.2% 0.5%E09000015 Harrow 08G NHS Hillingdon CCG 1.8% 2.0%E09000015 Harrow 08Y NHS West London (K&C & QPP) CCG 0.1% 0.1%

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E06000001 Hartlepool 00D NHS Durham Dales, Easington and Sedgefield CCG 0.2% 0.6%E06000001 Hartlepool 00K NHS Hartlepool and Stockton-On-Tees CCG 32.4% 99.4%E09000016 Havering 07L NHS Barking and Dagenham CCG 3.5% 2.9%E09000016 Havering 08F NHS Havering CCG 91.7% 96.2%E09000016 Havering 08M NHS Newham CCG 0.1% 0.2%E09000016 Havering 08N NHS Redbridge CCG 0.6% 0.7%E09000016 Havering 07G NHS Thurrock CCG 0.1% 0.0%E06000019 Herefordshire, County of 11M NHS Gloucestershire CCG 0.3% 0.9%E06000019 Herefordshire, County of 05F NHS Herefordshire CCG 98.2% 97.3%E06000019 Herefordshire, County of 05N NHS Shropshire CCG 0.3% 0.5%E06000019 Herefordshire, County of 05T NHS South Worcestershire CCG 0.8% 1.3%E10000015 Hertfordshire 07M NHS Barnet CCG 0.2% 0.0%E10000015 Hertfordshire 06F NHS Bedfordshire CCG 0.1% 0.0%E10000015 Hertfordshire 14Y NHS Buckinghamshire CCG 0.2% 0.1%E10000015 Hertfordshire 06H NHS Cambridgeshire and Peterborough CCG 2.1% 1.6%E10000015 Hertfordshire 06K NHS East and North Hertfordshire CCG 97.0% 46.5%E10000015 Hertfordshire 07X NHS Enfield CCG 0.5% 0.1%E10000015 Hertfordshire 08E NHS Harrow CCG 0.6% 0.1%E10000015 Hertfordshire 06N NHS Herts Valleys CCG 98.0% 50.7%E10000015 Hertfordshire 08G NHS Hillingdon CCG 2.2% 0.6%E10000015 Hertfordshire 06P NHS Luton CCG 0.4% 0.0%E10000015 Hertfordshire 07H NHS West Essex CCG 0.8% 0.2%E09000017 Hillingdon 14Y NHS Buckinghamshire CCG 0.0% 0.1%E09000017 Hillingdon 07W NHS Ealing CCG 5.2% 6.9%E09000017 Hillingdon 08C NHS Hammersmith and Fulham CCG 0.5% 0.3%E09000017 Hillingdon 08E NHS Harrow CCG 2.2% 1.8%E09000017 Hillingdon 08G NHS Hillingdon CCG 94.3% 89.8%E09000017 Hillingdon 07Y NHS Hounslow CCG 1.1% 1.0%E09000018 Hounslow 07W NHS Ealing CCG 5.4% 7.4%E09000018 Hounslow 08C NHS Hammersmith and Fulham CCG 1.2% 0.9%E09000018 Hounslow 08G NHS Hillingdon CCG 0.2% 0.2%E09000018 Hounslow 07Y NHS Hounslow CCG 88.2% 87.1%E09000018 Hounslow 09Y NHS North West Surrey CCG 0.3% 0.4%E09000018 Hounslow 08P NHS Richmond CCG 5.7% 3.8%E09000018 Hounslow 08Y NHS West London (K&C & QPP) CCG 0.2% 0.1%E06000046 Isle of Wight 10L NHS Isle of Wight CCG 100.0% 100.0%E09000019 Islington 07R NHS Camden CCG 4.9% 5.4%E09000019 Islington 09A NHS Central London (Westminster) CCG 0.5% 0.5%E09000019 Islington 07T NHS City and Hackney CCG 3.4% 4.2%E09000019 Islington 08C NHS Hammersmith and Fulham CCG 0.5% 0.5%E09000019 Islington 08D NHS Haringey CCG 1.2% 1.5%E09000019 Islington 08H NHS Islington CCG 89.1% 87.9%E09000020 Kensington and Chelsea 07P NHS Brent CCG 0.0% 0.1%E09000020 Kensington and Chelsea 07R NHS Camden CCG 0.2% 0.3%E09000020 Kensington and Chelsea 09A NHS Central London (Westminster) CCG 4.0% 5.4%E09000020 Kensington and Chelsea 08C NHS Hammersmith and Fulham CCG 1.2% 1.7%E09000020 Kensington and Chelsea 08Y NHS West London (K&C & QPP) CCG 63.9% 92.5%E10000016 Kent 09C NHS Ashford CCG 100.0% 8.3%E10000016 Kent 07N NHS Bexley CCG 1.3% 0.2%E10000016 Kent 07Q NHS Bromley CCG 0.9% 0.2%E10000016 Kent 09E NHS Canterbury and Coastal CCG 100.0% 14.1%E10000016 Kent 09J NHS Dartford, Gravesham and Swanley CCG 98.3% 16.5%E10000016 Kent 09L NHS East Surrey CCG 0.1% 0.0%E10000016 Kent 08A NHS Greenwich CCG 0.2% 0.0%E10000016 Kent 09P NHS Hastings and Rother CCG 0.3% 0.0%E10000016 Kent 99K NHS High Weald Lewes Havens CCG 0.6% 0.0%E10000016 Kent 09W NHS Medway CCG 6.1% 1.1%E10000016 Kent 10A NHS South Kent Coast CCG 100.0% 12.9%E10000016 Kent 10D NHS Swale CCG 99.8% 7.1%E10000016 Kent 10E NHS Thanet CCG 100.0% 9.1%E10000016 Kent 99J NHS West Kent CCG 98.7% 30.4%E06000010 Kingston upon Hull, City of 02Y NHS East Riding of Yorkshire CCG 1.3% 1.4%E06000010 Kingston upon Hull, City of 03F NHS Hull CCG 90.8% 98.6%E09000021 Kingston upon Thames 08J NHS Kingston CCG 86.9% 95.9%E09000021 Kingston upon Thames 08R NHS Merton CCG 1.1% 1.3%E09000021 Kingston upon Thames 08P NHS Richmond CCG 0.7% 0.8%E09000021 Kingston upon Thames 99H NHS Surrey Downs CCG 0.7% 1.2%E09000021 Kingston upon Thames 08T NHS Sutton CCG 0.1% 0.1%E09000021 Kingston upon Thames 08X NHS Wandsworth CCG 0.3% 0.7%E08000034 Kirklees 02P NHS Barnsley CCG 0.1% 0.0%E08000034 Kirklees 02R NHS Bradford Districts CCG 1.0% 0.7%E08000034 Kirklees 02T NHS Calderdale CCG 1.4% 0.7%E08000034 Kirklees 03A NHS Greater Huddersfield CCG 99.6% 54.7%E08000034 Kirklees 15F NHS Leeds CCG 0.1% 0.3%E08000034 Kirklees 03J NHS North Kirklees CCG 98.9% 42.4%E08000034 Kirklees 03R NHS Wakefield CCG 1.5% 1.3%

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E08000011 Knowsley 01F NHS Halton CCG 1.0% 0.8%E08000011 Knowsley 01J NHS Knowsley CCG 86.8% 88.2%E08000011 Knowsley 99A NHS Liverpool CCG 2.4% 8.0%E08000011 Knowsley 01T NHS South Sefton CCG 0.1% 0.1%E08000011 Knowsley 01X NHS St Helens CCG 2.3% 2.8%E09000022 Lambeth 07R NHS Camden CCG 0.2% 0.1%E09000022 Lambeth 09A NHS Central London (Westminster) CCG 0.9% 0.6%E09000022 Lambeth 07V NHS Croydon CCG 0.7% 0.8%E09000022 Lambeth 08C NHS Hammersmith and Fulham CCG 0.6% 0.4%E09000022 Lambeth 08K NHS Lambeth CCG 85.5% 92.2%E09000022 Lambeth 08R NHS Merton CCG 1.0% 0.6%E09000022 Lambeth 08Q NHS Southwark CCG 1.9% 1.6%E09000022 Lambeth 08X NHS Wandsworth CCG 3.5% 3.7%E09000022 Lambeth 08Y NHS West London (K&C & QPP) CCG 0.1% 0.0%E10000017 Lancashire 02N NHS Airedale, Wharfdale and Craven CCG 0.2% 0.0%E10000017 Lancashire 00Q NHS Blackburn with Darwen CCG 11.1% 1.5%E10000017 Lancashire 00R NHS Blackpool CCG 13.6% 1.9%E10000017 Lancashire 00T NHS Bolton CCG 0.3% 0.0%E10000017 Lancashire 00V NHS Bury CCG 1.4% 0.2%E10000017 Lancashire 00X NHS Chorley and South Ribble CCG 99.8% 14.5%E10000017 Lancashire 01A NHS East Lancashire CCG 99.0% 30.0%E10000017 Lancashire 02M NHS Fylde & Wyre CCG 97.9% 13.8%E10000017 Lancashire 01E NHS Greater Preston CCG 100.0% 16.6%E10000017 Lancashire 01D NHS Heywood, Middleton and Rochdale CCG 0.9% 0.2%E10000017 Lancashire 01J NHS Knowsley CCG 0.1% 0.0%E10000017 Lancashire 01K NHS Morecambe Bay CCG 44.1% 12.1%E10000017 Lancashire 01T NHS South Sefton CCG 0.5% 0.0%E10000017 Lancashire 01V NHS Southport and Formby CCG 3.2% 0.3%E10000017 Lancashire 01X NHS St Helens CCG 0.5% 0.0%E10000017 Lancashire 02G NHS West Lancashire CCG 96.9% 8.7%E10000017 Lancashire 02H NHS Wigan Borough CCG 0.7% 0.2%E08000035 Leeds 02N NHS Airedale, Wharfdale and Craven CCG 0.1% 0.0%E08000035 Leeds 02W NHS Bradford City CCG 1.1% 0.2%E08000035 Leeds 02R NHS Bradford Districts CCG 0.5% 0.2%E08000035 Leeds 15F NHS Leeds CCG 97.7% 98.8%E08000035 Leeds 03J NHS North Kirklees CCG 0.3% 0.0%E08000035 Leeds 03Q NHS Vale of York CCG 0.6% 0.2%E08000035 Leeds 03R NHS Wakefield CCG 1.4% 0.6%E06000016 Leicester 03W NHS East Leicestershire and Rutland CCG 2.1% 1.8%E06000016 Leicester 04C NHS Leicester City CCG 92.8% 95.5%E06000016 Leicester 04V NHS West Leicestershire CCG 2.8% 2.7%E10000018 Leicestershire 03V NHS Corby CCG 0.5% 0.0%E10000018 Leicestershire 15M NHS Derby and Derbyshire CCG 0.4% 0.6%E10000018 Leicestershire 03W NHS East Leicestershire and Rutland CCG 85.5% 39.8%E10000018 Leicestershire 04C NHS Leicester City CCG 7.2% 4.1%E10000018 Leicestershire 04N NHS Rushcliffe CCG 5.4% 1.0%E10000018 Leicestershire 04Q NHS South West Lincolnshire CCG 5.6% 1.1%E10000018 Leicestershire 05H NHS Warwickshire North CCG 1.6% 0.4%E10000018 Leicestershire 04V NHS West Leicestershire CCG 96.2% 53.1%E09000023 Lewisham 07Q NHS Bromley CCG 1.4% 1.5%E09000023 Lewisham 09A NHS Central London (Westminster) CCG 0.2% 0.2%E09000023 Lewisham 08A NHS Greenwich CCG 2.1% 1.9%E09000023 Lewisham 08C NHS Hammersmith and Fulham CCG 0.3% 0.2%E09000023 Lewisham 08K NHS Lambeth CCG 0.3% 0.4%E09000023 Lewisham 08L NHS Lewisham CCG 91.5% 92.0%E09000023 Lewisham 08Q NHS Southwark CCG 3.9% 3.9%E10000019 Lincolnshire 06H NHS Cambridgeshire and Peterborough CCG 0.2% 0.3%E10000019 Lincolnshire 03W NHS East Leicestershire and Rutland CCG 0.2% 0.1%E10000019 Lincolnshire 03T NHS Lincolnshire East CCG 99.2% 32.0%E10000019 Lincolnshire 04D NHS Lincolnshire West CCG 98.6% 29.9%E10000019 Lincolnshire 04H NHS Newark & Sherwood CCG 2.4% 0.4%E10000019 Lincolnshire 03H NHS North East Lincolnshire CCG 2.7% 0.6%E10000019 Lincolnshire 03K NHS North Lincolnshire CCG 4.9% 1.1%E10000019 Lincolnshire 99D NHS South Lincolnshire CCG 90.8% 19.6%E10000019 Lincolnshire 04Q NHS South West Lincolnshire CCG 93.3% 16.1%E08000012 Liverpool 01J NHS Knowsley CCG 8.5% 2.7%E08000012 Liverpool 99A NHS Liverpool CCG 94.4% 96.3%E08000012 Liverpool 01T NHS South Sefton CCG 3.3% 1.0%E06000032 Luton 06F NHS Bedfordshire CCG 2.3% 4.5%E06000032 Luton 06P NHS Luton CCG 97.3% 95.5%E08000003 Manchester 00V NHS Bury CCG 0.4% 0.1%E08000003 Manchester 01D NHS Heywood, Middleton and Rochdale CCG 0.5% 0.2%E08000003 Manchester 14L NHS Manchester CCG 90.9% 95.6%E08000003 Manchester 00Y NHS Oldham CCG 0.9% 0.4%E08000003 Manchester 01G NHS Salford CCG 2.5% 1.1%E08000003 Manchester 01W NHS Stockport CCG 1.7% 0.8%E08000003 Manchester 01Y NHS Tameside and Glossop CCG 0.4% 0.2%E08000003 Manchester 02A NHS Trafford CCG 4.0% 1.6%

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E06000035 Medway 09J NHS Dartford, Gravesham and Swanley CCG 0.2% 0.2%E06000035 Medway 09W NHS Medway CCG 93.9% 99.5%E06000035 Medway 10D NHS Swale CCG 0.2% 0.0%E06000035 Medway 99J NHS West Kent CCG 0.2% 0.3%E09000024 Merton 07V NHS Croydon CCG 0.5% 0.9%E09000024 Merton 08C NHS Hammersmith and Fulham CCG 0.2% 0.2%E09000024 Merton 08J NHS Kingston CCG 3.4% 2.9%E09000024 Merton 08K NHS Lambeth CCG 1.0% 1.7%E09000024 Merton 08R NHS Merton CCG 87.7% 80.9%E09000024 Merton 08T NHS Sutton CCG 3.3% 2.6%E09000024 Merton 08X NHS Wandsworth CCG 6.6% 10.8%E06000002 Middlesbrough 03D NHS Hambleton, Richmondshire and Whitby CCG 0.2% 0.2%E06000002 Middlesbrough 00K NHS Hartlepool and Stockton-On-Tees CCG 0.2% 0.3%E06000002 Middlesbrough 00M NHS South Tees CCG 52.3% 99.5%E06000042 Milton Keynes 06F NHS Bedfordshire CCG 1.5% 2.5%E06000042 Milton Keynes 04F NHS Milton Keynes CCG 95.5% 96.2%E06000042 Milton Keynes 04G NHS Nene CCG 0.6% 1.3%E08000021 Newcastle upon Tyne 13T NHS Newcastle Gateshead CCG 58.9% 95.2%E08000021 Newcastle upon Tyne 99C NHS North Tyneside CCG 5.9% 4.0%E08000021 Newcastle upon Tyne 00L NHS Northumberland CCG 0.8% 0.8%E09000025 Newham 07L NHS Barking and Dagenham CCG 0.5% 0.3%E09000025 Newham 09A NHS Central London (Westminster) CCG 0.7% 0.4%E09000025 Newham 07T NHS City and Hackney CCG 0.1% 0.0%E09000025 Newham 08C NHS Hammersmith and Fulham CCG 0.5% 0.3%E09000025 Newham 08M NHS Newham CCG 96.6% 97.3%E09000025 Newham 08N NHS Redbridge CCG 0.3% 0.2%E09000025 Newham 08V NHS Tower Hamlets CCG 0.2% 0.2%E09000025 Newham 08W NHS Waltham Forest CCG 1.7% 1.4%E10000020 Norfolk 06H NHS Cambridgeshire and Peterborough CCG 0.7% 0.7%E10000020 Norfolk 06M NHS Great Yarmouth and Waveney CCG 47.7% 12.2%E10000020 Norfolk 06L NHS Ipswich and East Suffolk CCG 0.2% 0.0%E10000020 Norfolk 06V NHS North Norfolk CCG 100.0% 18.6%E10000020 Norfolk 06W NHS Norwich CCG 100.0% 25.2%E10000020 Norfolk 99D NHS South Lincolnshire CCG 0.2% 0.0%E10000020 Norfolk 06Y NHS South Norfolk CCG 98.9% 24.1%E10000020 Norfolk 07J NHS West Norfolk CCG 98.4% 18.5%E10000020 Norfolk 07K NHS West Suffolk CCG 2.6% 0.7%E06000012 North East Lincolnshire 03T NHS Lincolnshire East CCG 0.8% 1.2%E06000012 North East Lincolnshire 03H NHS North East Lincolnshire CCG 95.9% 98.6%E06000012 North East Lincolnshire 03K NHS North Lincolnshire CCG 0.2% 0.2%E06000013 North Lincolnshire 02Q NHS Bassetlaw CCG 0.2% 0.2%E06000013 North Lincolnshire 02X NHS Doncaster CCG 0.0% 0.1%E06000013 North Lincolnshire 02Y NHS East Riding of Yorkshire CCG 0.0% 0.1%E06000013 North Lincolnshire 04D NHS Lincolnshire West CCG 1.0% 1.3%E06000013 North Lincolnshire 03H NHS North East Lincolnshire CCG 1.4% 1.4%E06000013 North Lincolnshire 03K NHS North Lincolnshire CCG 94.9% 96.9%E06000024 North Somerset 11E NHS Bath and North East Somerset CCG 1.6% 1.5%E06000024 North Somerset 15C NHS Bristol, North Somerset and South Gloucestershire CCG 21.8% 98.3%E06000024 North Somerset 11X NHS Somerset CCG 0.0% 0.2%E08000022 North Tyneside 13T NHS Newcastle Gateshead CCG 1.0% 2.6%E08000022 North Tyneside 99C NHS North Tyneside CCG 93.2% 96.3%E08000022 North Tyneside 00L NHS Northumberland CCG 0.7% 1.1%E10000023 North Yorkshire 02N NHS Airedale, Wharfdale and Craven CCG 32.5% 8.3%E10000023 North Yorkshire 00C NHS Darlington CCG 1.3% 0.2%E10000023 North Yorkshire 02X NHS Doncaster CCG 0.2% 0.1%E10000023 North Yorkshire 00D NHS Durham Dales, Easington and Sedgefield CCG 0.2% 0.1%E10000023 North Yorkshire 01A NHS East Lancashire CCG 0.1% 0.0%E10000023 North Yorkshire 02Y NHS East Riding of Yorkshire CCG 1.4% 0.7%E10000023 North Yorkshire 03D NHS Hambleton, Richmondshire and Whitby CCG 98.3% 22.8%E10000023 North Yorkshire 03E NHS Harrogate and Rural District CCG 99.8% 26.2%E10000023 North Yorkshire 00K NHS Hartlepool and Stockton-On-Tees CCG 0.2% 0.1%E10000023 North Yorkshire 15F NHS Leeds CCG 0.9% 1.3%E10000023 North Yorkshire 01K NHS Morecambe Bay CCG 1.9% 1.0%E10000023 North Yorkshire 03M NHS Scarborough and Ryedale CCG 99.3% 19.2%E10000023 North Yorkshire 03Q NHS Vale of York CCG 32.6% 18.8%E10000023 North Yorkshire 03R NHS Wakefield CCG 2.0% 1.2%E10000021 Northamptonshire 06F NHS Bedfordshire CCG 0.1% 0.0%E10000021 Northamptonshire 06H NHS Cambridgeshire and Peterborough CCG 1.6% 1.9%E10000021 Northamptonshire 03V NHS Corby CCG 99.2% 9.8%E10000021 Northamptonshire 05A NHS Coventry and Rugby CCG 0.3% 0.2%E10000021 Northamptonshire 03W NHS East Leicestershire and Rutland CCG 2.0% 0.8%E10000021 Northamptonshire 04F NHS Milton Keynes CCG 3.1% 1.2%E10000021 Northamptonshire 04G NHS Nene CCG 98.8% 84.9%E10000021 Northamptonshire 10Q NHS Oxfordshire CCG 1.1% 1.0%E10000021 Northamptonshire 99D NHS South Lincolnshire CCG 0.9% 0.2%E06000057 Northumberland 13T NHS Newcastle Gateshead CCG 0.3% 0.5%E06000057 Northumberland 01H NHS North Cumbria CCG 0.1% 0.1%E06000057 Northumberland 00J NHS North Durham CCG 0.2% 0.2%E06000057 Northumberland 99C NHS North Tyneside CCG 0.9% 0.6%E06000057 Northumberland 00L NHS Northumberland CCG 97.9% 98.7%

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E06000018 Nottingham 04K NHS Nottingham City CCG 89.9% 95.4%E06000018 Nottingham 04L NHS Nottingham North and East CCG 4.6% 2.0%E06000018 Nottingham 04M NHS Nottingham West CCG 4.1% 1.1%E06000018 Nottingham 04N NHS Rushcliffe CCG 4.3% 1.5%E10000024 Nottinghamshire 02Q NHS Bassetlaw CCG 97.1% 13.5%E10000024 Nottinghamshire 15M NHS Derby and Derbyshire CCG 1.5% 1.8%E10000024 Nottinghamshire 02X NHS Doncaster CCG 1.6% 0.6%E10000024 Nottinghamshire 03W NHS East Leicestershire and Rutland CCG 0.3% 0.1%E10000024 Nottinghamshire 04D NHS Lincolnshire West CCG 0.4% 0.1%E10000024 Nottinghamshire 04E NHS Mansfield and Ashfield CCG 97.9% 22.5%E10000024 Nottinghamshire 04H NHS Newark & Sherwood CCG 97.6% 15.6%E10000024 Nottinghamshire 04K NHS Nottingham City CCG 10.1% 4.6%E10000024 Nottinghamshire 04L NHS Nottingham North and East CCG 95.1% 17.2%E10000024 Nottinghamshire 04M NHS Nottingham West CCG 90.8% 10.2%E10000024 Nottinghamshire 04N NHS Rushcliffe CCG 90.3% 13.6%E10000024 Nottinghamshire 04Q NHS South West Lincolnshire CCG 0.7% 0.1%E10000024 Nottinghamshire 04V NHS West Leicestershire CCG 0.1% 0.0%E08000004 Oldham 01D NHS Heywood, Middleton and Rochdale CCG 1.5% 1.4%E08000004 Oldham 14L NHS Manchester CCG 0.8% 2.1%E08000004 Oldham 00Y NHS Oldham CCG 94.5% 96.3%E08000004 Oldham 01Y NHS Tameside and Glossop CCG 0.2% 0.2%E10000025 Oxfordshire 15A NHS Berkshire West CCG 0.5% 0.3%E10000025 Oxfordshire 14Y NHS Buckinghamshire CCG 2.4% 1.8%E10000025 Oxfordshire 11M NHS Gloucestershire CCG 0.2% 0.2%E10000025 Oxfordshire 04G NHS Nene CCG 0.1% 0.1%E10000025 Oxfordshire 10Q NHS Oxfordshire CCG 97.4% 96.5%E10000025 Oxfordshire 05R NHS South Warwickshire CCG 0.6% 0.2%E10000025 Oxfordshire 12D NHS Swindon CCG 2.7% 0.9%E06000031 Peterborough 06H NHS Cambridgeshire and Peterborough CCG 23.0% 96.3%E06000031 Peterborough 99D NHS South Lincolnshire CCG 5.1% 3.7%E06000026 Plymouth 15N NHS Devon CCG 22.1% 100.0%E06000044 Portsmouth 10K NHS Fareham and Gosport CCG 1.5% 1.4%E06000044 Portsmouth 10R NHS Portsmouth CCG 95.6% 98.4%E06000044 Portsmouth 10V NHS South Eastern Hampshire CCG 0.2% 0.2%E06000038 Reading 15A NHS Berkshire West CCG 35.3% 99.4%E06000038 Reading 10Q NHS Oxfordshire CCG 0.2% 0.6%E09000026 Redbridge 07L NHS Barking and Dagenham CCG 4.9% 3.3%E09000026 Redbridge 08C NHS Hammersmith and Fulham CCG 0.1% 0.1%E09000026 Redbridge 08F NHS Havering CCG 0.8% 0.7%E09000026 Redbridge 08M NHS Newham CCG 1.4% 1.7%E09000026 Redbridge 08N NHS Redbridge CCG 92.3% 89.4%E09000026 Redbridge 08W NHS Waltham Forest CCG 3.3% 3.1%E09000026 Redbridge 07H NHS West Essex CCG 1.8% 1.7%E06000003 Redcar and Cleveland 03D NHS Hambleton, Richmondshire and Whitby CCG 1.1% 1.1%E06000003 Redcar and Cleveland 00M NHS South Tees CCG 47.3% 98.9%E09000027 Richmond upon Thames 08C NHS Hammersmith and Fulham CCG 0.5% 0.5%E09000027 Richmond upon Thames 07Y NHS Hounslow CCG 4.9% 7.0%E09000027 Richmond upon Thames 08J NHS Kingston CCG 1.6% 1.5%E09000027 Richmond upon Thames 08P NHS Richmond CCG 91.7% 90.3%E09000027 Richmond upon Thames 99H NHS Surrey Downs CCG 0.0% 0.1%E09000027 Richmond upon Thames 08X NHS Wandsworth CCG 0.4% 0.7%E08000005 Rochdale 00V NHS Bury CCG 0.7% 0.6%E08000005 Rochdale 01A NHS East Lancashire CCG 0.2% 0.3%E08000005 Rochdale 01D NHS Heywood, Middleton and Rochdale CCG 96.5% 96.6%E08000005 Rochdale 14L NHS Manchester CCG 0.6% 1.6%E08000005 Rochdale 00Y NHS Oldham CCG 0.9% 1.0%E08000018 Rotherham 02P NHS Barnsley CCG 3.3% 3.1%E08000018 Rotherham 02Q NHS Bassetlaw CCG 1.0% 0.4%E08000018 Rotherham 02X NHS Doncaster CCG 1.1% 1.2%E08000018 Rotherham 03L NHS Rotherham CCG 97.9% 93.5%E08000018 Rotherham 03N NHS Sheffield CCG 0.8% 1.7%E06000017 Rutland 06H NHS Cambridgeshire and Peterborough CCG 0.0% 0.3%E06000017 Rutland 03V NHS Corby CCG 0.2% 0.5%E06000017 Rutland 03W NHS East Leicestershire and Rutland CCG 9.9% 86.3%E06000017 Rutland 99D NHS South Lincolnshire CCG 2.6% 11.5%E06000017 Rutland 04Q NHS South West Lincolnshire CCG 0.4% 1.4%E08000006 Salford 00T NHS Bolton CCG 0.2% 0.3%E08000006 Salford 00V NHS Bury CCG 1.8% 1.4%E08000006 Salford 14L NHS Manchester CCG 1.1% 2.5%E08000006 Salford 01G NHS Salford CCG 94.1% 94.6%E08000006 Salford 02A NHS Trafford CCG 0.2% 0.2%E08000006 Salford 02H NHS Wigan Borough CCG 0.9% 1.1%E08000028 Sandwell 15E NHS Birmingham and Solihull CCG 1.9% 7.0%E08000028 Sandwell 05C NHS Dudley CCG 3.0% 2.7%E08000028 Sandwell 05L NHS Sandwell and West Birmingham CCG 55.1% 88.6%E08000028 Sandwell 05Y NHS Walsall CCG 1.7% 1.3%E08000028 Sandwell 06A NHS Wolverhampton CCG 0.3% 0.3%E08000014 Sefton 01J NHS Knowsley CCG 1.8% 1.0%E08000014 Sefton 99A NHS Liverpool CCG 2.9% 5.3%E08000014 Sefton 01T NHS South Sefton CCG 96.0% 51.6%E08000014 Sefton 01V NHS Southport and Formby CCG 96.8% 41.9%E08000014 Sefton 02G NHS West Lancashire CCG 0.3% 0.1%

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E08000019 Sheffield 02P NHS Barnsley CCG 0.8% 0.4%E08000019 Sheffield 15M NHS Derby and Derbyshire CCG 0.2% 0.4%E08000019 Sheffield 03L NHS Rotherham CCG 0.4% 0.2%E08000019 Sheffield 03N NHS Sheffield CCG 98.5% 99.1%E06000051 Shropshire 05F NHS Herefordshire CCG 0.4% 0.3%E06000051 Shropshire 05G NHS North Staffordshire CCG 0.5% 0.3%E06000051 Shropshire 05N NHS Shropshire CCG 96.7% 95.4%E06000051 Shropshire 01R NHS South Cheshire CCG 0.4% 0.3%E06000051 Shropshire 05Q NHS South East Staffs and Seisdon Peninsular CCG 1.2% 0.9%E06000051 Shropshire 05T NHS South Worcestershire CCG 1.0% 1.0%E06000051 Shropshire 05X NHS Telford and Wrekin CCG 2.3% 1.4%E06000051 Shropshire 02F NHS West Cheshire CCG 0.1% 0.1%E06000051 Shropshire 06D NHS Wyre Forest CCG 0.8% 0.3%E06000039 Slough 14Y NHS Buckinghamshire CCG 1.8% 6.2%E06000039 Slough 07W NHS Ealing CCG 0.0% 0.1%E06000039 Slough 15D NHS East Berkshire CCG 33.8% 93.4%E06000039 Slough 08G NHS Hillingdon CCG 0.0% 0.1%E06000039 Slough 07Y NHS Hounslow CCG 0.0% 0.1%E06000039 Slough 09Y NHS North West Surrey CCG 0.0% 0.1%E08000029 Solihull 15E NHS Birmingham and Solihull CCG 17.0% 98.9%E08000029 Solihull 05A NHS Coventry and Rugby CCG 0.0% 0.1%E08000029 Solihull 05J NHS Redditch and Bromsgrove CCG 0.4% 0.3%E08000029 Solihull 05L NHS Sandwell and West Birmingham CCG 0.0% 0.1%E08000029 Solihull 05R NHS South Warwickshire CCG 0.4% 0.4%E08000029 Solihull 05H NHS Warwickshire North CCG 0.2% 0.2%E10000027 Somerset 11E NHS Bath and North East Somerset CCG 3.1% 1.1%E10000027 Somerset 15C NHS Bristol, North Somerset and South Gloucestershire CCG 0.2% 0.3%E10000027 Somerset 15N NHS Devon CCG 0.2% 0.5%E10000027 Somerset 11J NHS Dorset CCG 0.5% 0.7%E10000027 Somerset 11X NHS Somerset CCG 98.5% 97.3%E10000027 Somerset 99N NHS Wiltshire CCG 0.1% 0.1%E06000025 South Gloucestershire 11E NHS Bath and North East Somerset CCG 0.8% 0.6%E06000025 South Gloucestershire 15C NHS Bristol, North Somerset and South Gloucestershire CCG 28.2% 97.5%E06000025 South Gloucestershire 11M NHS Gloucestershire CCG 0.8% 1.8%E06000025 South Gloucestershire 99N NHS Wiltshire CCG 0.0% 0.1%E08000023 South Tyneside 13T NHS Newcastle Gateshead CCG 0.0% 0.2%E08000023 South Tyneside 00N NHS South Tyneside CCG 99.2% 99.2%E08000023 South Tyneside 00P NHS Sunderland CCG 0.3% 0.6%E06000045 Southampton 10X NHS Southampton CCG 94.9% 99.5%E06000045 Southampton 11A NHS West Hampshire CCG 0.2% 0.5%E06000033 Southend-on-Sea 99F NHS Castle Point and Rochford CCG 4.8% 4.7%E06000033 Southend-on-Sea 99G NHS Southend CCG 96.7% 95.3%E09000028 Southwark 07R NHS Camden CCG 0.3% 0.3%E09000028 Southwark 09A NHS Central London (Westminster) CCG 2.5% 1.6%E09000028 Southwark 08C NHS Hammersmith and Fulham CCG 0.7% 0.5%E09000028 Southwark 08K NHS Lambeth CCG 6.6% 7.7%E09000028 Southwark 08L NHS Lewisham CCG 2.1% 2.0%E09000028 Southwark 08Q NHS Southwark CCG 94.1% 87.9%E09000028 Southwark 08X NHS Wandsworth CCG 0.1% 0.1%E08000013 St. Helens 01F NHS Halton CCG 0.2% 0.1%E08000013 St. Helens 01J NHS Knowsley CCG 2.6% 2.3%E08000013 St. Helens 01X NHS St Helens CCG 91.2% 96.3%E08000013 St. Helens 02E NHS Warrington CCG 0.1% 0.1%E08000013 St. Helens 02H NHS Wigan Borough CCG 0.7% 1.2%E10000028 Staffordshire 15E NHS Birmingham and Solihull CCG 0.3% 0.4%E10000028 Staffordshire 04Y NHS Cannock Chase CCG 99.3% 14.9%E10000028 Staffordshire 15M NHS Derby and Derbyshire CCG 0.5% 0.5%E10000028 Staffordshire 05C NHS Dudley CCG 1.4% 0.5%E10000028 Staffordshire 05D NHS East Staffordshire CCG 92.1% 14.7%E10000028 Staffordshire 01C NHS Eastern Cheshire CCG 0.6% 0.1%E10000028 Staffordshire 05G NHS North Staffordshire CCG 95.1% 23.4%E10000028 Staffordshire 05N NHS Shropshire CCG 1.0% 0.3%E10000028 Staffordshire 01R NHS South Cheshire CCG 0.5% 0.1%E10000028 Staffordshire 05Q NHS South East Staffs and Seisdon Peninsular CCG 96.2% 23.6%E10000028 Staffordshire 05V NHS Stafford and Surrounds CCG 99.5% 16.7%E10000028 Staffordshire 05W NHS Stoke on Trent CCG 8.8% 2.9%E10000028 Staffordshire 05X NHS Telford and Wrekin CCG 1.0% 0.2%E10000028 Staffordshire 05Y NHS Walsall CCG 1.6% 0.5%E10000028 Staffordshire 05H NHS Warwickshire North CCG 1.1% 0.2%E10000028 Staffordshire 06A NHS Wolverhampton CCG 2.6% 0.8%E10000028 Staffordshire 06D NHS Wyre Forest CCG 0.2% 0.0%E08000007 Stockport 01C NHS Eastern Cheshire CCG 1.6% 1.1%E08000007 Stockport 14L NHS Manchester CCG 1.1% 2.2%E08000007 Stockport 01W NHS Stockport CCG 94.9% 96.5%E08000007 Stockport 01Y NHS Tameside and Glossop CCG 0.2% 0.2%E06000004 Stockton-on-Tees 00C NHS Darlington CCG 0.4% 0.2%E06000004 Stockton-on-Tees 00D NHS Durham Dales, Easington and Sedgefield CCG 0.4% 0.6%E06000004 Stockton-on-Tees 03D NHS Hambleton, Richmondshire and Whitby CCG 0.1% 0.1%E06000004 Stockton-on-Tees 00K NHS Hartlepool and Stockton-On-Tees CCG 66.9% 98.4%E06000004 Stockton-on-Tees 00M NHS South Tees CCG 0.4% 0.7%

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E06000021 Stoke-on-Trent 05G NHS North Staffordshire CCG 3.3% 2.7%E06000021 Stoke-on-Trent 05V NHS Stafford and Surrounds CCG 0.5% 0.3%E06000021 Stoke-on-Trent 05W NHS Stoke on Trent CCG 91.2% 97.1%E10000029 Suffolk 06H NHS Cambridgeshire and Peterborough CCG 0.2% 0.2%E10000029 Suffolk 06M NHS Great Yarmouth and Waveney CCG 52.3% 16.3%E10000029 Suffolk 06L NHS Ipswich and East Suffolk CCG 99.6% 52.9%E10000029 Suffolk 06T NHS North East Essex CCG 1.4% 0.6%E10000029 Suffolk 06Y NHS South Norfolk CCG 1.1% 0.3%E10000029 Suffolk 07H NHS West Essex CCG 0.1% 0.0%E10000029 Suffolk 07K NHS West Suffolk CCG 91.1% 29.7%E08000024 Sunderland 00D NHS Durham Dales, Easington and Sedgefield CCG 0.9% 0.9%E08000024 Sunderland 13T NHS Newcastle Gateshead CCG 0.5% 0.9%E08000024 Sunderland 00J NHS North Durham CCG 2.2% 1.9%E08000024 Sunderland 00N NHS South Tyneside CCG 0.5% 0.3%E08000024 Sunderland 00P NHS Sunderland CCG 98.5% 96.0%E10000030 Surrey 07Q NHS Bromley CCG 0.4% 0.1%E10000030 Surrey 09G NHS Coastal West Sussex CCG 0.2% 0.0%E10000030 Surrey 09H NHS Crawley CCG 6.6% 0.7%E10000030 Surrey 07V NHS Croydon CCG 1.3% 0.4%E10000030 Surrey 15D NHS East Berkshire CCG 3.4% 1.2%E10000030 Surrey 09L NHS East Surrey CCG 96.6% 14.1%E10000030 Surrey 09N NHS Guildford and Waverley CCG 94.0% 16.9%E10000030 Surrey 09X NHS Horsham and Mid Sussex CCG 1.5% 0.3%E10000030 Surrey 07Y NHS Hounslow CCG 0.7% 0.2%E10000030 Surrey 08J NHS Kingston CCG 4.5% 0.7%E10000030 Surrey 08R NHS Merton CCG 0.3% 0.0%E10000030 Surrey 99M NHS North East Hampshire and Farnham CCG 23.0% 4.2%E10000030 Surrey 10J NHS North Hampshire CCG 0.1% 0.0%E10000030 Surrey 09Y NHS North West Surrey CCG 99.4% 29.5%E10000030 Surrey 08P NHS Richmond CCG 0.7% 0.1%E10000030 Surrey 10V NHS South Eastern Hampshire CCG 0.1% 0.0%E10000030 Surrey 99H NHS Surrey Downs CCG 97.4% 23.8%E10000030 Surrey 10C NHS Surrey Heath CCG 98.9% 7.6%E10000030 Surrey 08T NHS Sutton CCG 1.2% 0.2%E10000030 Surrey 99J NHS West Kent CCG 0.2% 0.0%E09000029 Sutton 07V NHS Croydon CCG 1.0% 1.9%E09000029 Sutton 08J NHS Kingston CCG 3.5% 3.4%E09000029 Sutton 08K NHS Lambeth CCG 0.1% 0.2%E09000029 Sutton 08R NHS Merton CCG 6.3% 6.7%E09000029 Sutton 99H NHS Surrey Downs CCG 1.3% 1.9%E09000029 Sutton 08T NHS Sutton CCG 94.7% 85.6%E09000029 Sutton 08X NHS Wandsworth CCG 0.2% 0.3%E06000030 Swindon 11M NHS Gloucestershire CCG 0.0% 0.2%E06000030 Swindon 12D NHS Swindon CCG 96.0% 98.2%E06000030 Swindon 99N NHS Wiltshire CCG 0.7% 1.5%E08000008 Tameside 14L NHS Manchester CCG 2.2% 5.8%E08000008 Tameside 00Y NHS Oldham CCG 3.6% 3.9%E08000008 Tameside 01W NHS Stockport CCG 1.8% 2.3%E08000008 Tameside 01Y NHS Tameside and Glossop CCG 85.2% 88.0%E06000020 Telford and Wrekin 05N NHS Shropshire CCG 1.8% 2.9%E06000020 Telford and Wrekin 05X NHS Telford and Wrekin CCG 96.7% 97.1%E06000034 Thurrock 07L NHS Barking and Dagenham CCG 0.3% 0.3%E06000034 Thurrock 99E NHS Basildon and Brentwood CCG 0.2% 0.3%E06000034 Thurrock 08F NHS Havering CCG 0.2% 0.4%E06000034 Thurrock 07G NHS Thurrock CCG 98.5% 99.0%E06000027 Torbay 15N NHS Devon CCG 11.7% 100.0%E09000030 Tower Hamlets 07R NHS Camden CCG 1.1% 0.9%E09000030 Tower Hamlets 09A NHS Central London (Westminster) CCG 0.5% 0.3%E09000030 Tower Hamlets 07T NHS City and Hackney CCG 0.9% 0.9%E09000030 Tower Hamlets 08C NHS Hammersmith and Fulham CCG 0.8% 0.5%E09000030 Tower Hamlets 08H NHS Islington CCG 0.2% 0.1%E09000030 Tower Hamlets 08M NHS Newham CCG 0.2% 0.2%E09000030 Tower Hamlets 08V NHS Tower Hamlets CCG 98.9% 96.9%E08000009 Trafford 14L NHS Manchester CCG 2.7% 7.0%E08000009 Trafford 01G NHS Salford CCG 0.1% 0.1%E08000009 Trafford 02A NHS Trafford CCG 95.7% 92.7%E08000009 Trafford 02E NHS Warrington CCG 0.1% 0.1%E08000036 Wakefield 02P NHS Barnsley CCG 0.9% 0.6%E08000036 Wakefield 15F NHS Leeds CCG 0.4% 1.0%E08000036 Wakefield 03J NHS North Kirklees CCG 0.6% 0.3%E08000036 Wakefield 03R NHS Wakefield CCG 94.5% 98.0%E08000030 Walsall 15E NHS Birmingham and Solihull CCG 1.1% 4.8%E08000030 Walsall 04Y NHS Cannock Chase CCG 0.7% 0.3%E08000030 Walsall 05L NHS Sandwell and West Birmingham CCG 1.6% 3.1%E08000030 Walsall 05Y NHS Walsall CCG 92.8% 90.4%E08000030 Walsall 06A NHS Wolverhampton CCG 1.4% 1.4%E09000031 Waltham Forest 07T NHS City and Hackney CCG 0.4% 0.4%E09000031 Waltham Forest 08C NHS Hammersmith and Fulham CCG 0.3% 0.2%E09000031 Waltham Forest 08D NHS Haringey CCG 0.1% 0.1%E09000031 Waltham Forest 08M NHS Newham CCG 1.3% 1.7%E09000031 Waltham Forest 08N NHS Redbridge CCG 1.4% 1.4%E09000031 Waltham Forest 08W NHS Waltham Forest CCG 94.3% 96.1%

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E09000032 Wandsworth 09A NHS Central London (Westminster) CCG 0.9% 0.6%E09000032 Wandsworth 08C NHS Hammersmith and Fulham CCG 1.0% 0.6%E09000032 Wandsworth 08J NHS Kingston CCG 0.1% 0.0%E09000032 Wandsworth 08K NHS Lambeth CCG 3.2% 3.5%E09000032 Wandsworth 08R NHS Merton CCG 2.8% 1.6%E09000032 Wandsworth 08P NHS Richmond CCG 1.3% 0.7%E09000032 Wandsworth 08X NHS Wandsworth CCG 88.3% 92.6%E09000032 Wandsworth 08Y NHS West London (K&C & QPP) CCG 0.7% 0.4%E06000007 Warrington 01F NHS Halton CCG 0.3% 0.2%E06000007 Warrington 01G NHS Salford CCG 0.5% 0.6%E06000007 Warrington 01X NHS St Helens CCG 2.2% 2.0%E06000007 Warrington 02E NHS Warrington CCG 97.6% 97.0%E06000007 Warrington 02H NHS Wigan Borough CCG 0.2% 0.2%E10000031 Warwickshire 15E NHS Birmingham and Solihull CCG 0.2% 0.5%E10000031 Warwickshire 05A NHS Coventry and Rugby CCG 25.2% 21.5%E10000031 Warwickshire 11M NHS Gloucestershire CCG 0.2% 0.2%E10000031 Warwickshire 04G NHS Nene CCG 0.2% 0.2%E10000031 Warwickshire 10Q NHS Oxfordshire CCG 0.3% 0.3%E10000031 Warwickshire 05J NHS Redditch and Bromsgrove CCG 0.7% 0.2%E10000031 Warwickshire 05Q NHS South East Staffs and Seisdon Peninsular CCG 0.8% 0.3%E10000031 Warwickshire 05R NHS South Warwickshire CCG 96.1% 45.8%E10000031 Warwickshire 05H NHS Warwickshire North CCG 96.7% 30.7%E10000031 Warwickshire 04V NHS West Leicestershire CCG 0.5% 0.3%E06000037 West Berkshire 15A NHS Berkshire West CCG 30.0% 97.6%E06000037 West Berkshire 10J NHS North Hampshire CCG 0.7% 0.9%E06000037 West Berkshire 10Q NHS Oxfordshire CCG 0.2% 1.1%E06000037 West Berkshire 99N NHS Wiltshire CCG 0.1% 0.4%E10000032 West Sussex 09D NHS Brighton and Hove CCG 1.1% 0.4%E10000032 West Sussex 09G NHS Coastal West Sussex CCG 99.5% 57.5%E10000032 West Sussex 09H NHS Crawley CCG 93.4% 14.0%E10000032 West Sussex 09L NHS East Surrey CCG 0.3% 0.0%E10000032 West Sussex 09N NHS Guildford and Waverley CCG 3.1% 0.8%E10000032 West Sussex 99K NHS High Weald Lewes Havens CCG 1.1% 0.2%E10000032 West Sussex 09X NHS Horsham and Mid Sussex CCG 95.7% 25.9%E10000032 West Sussex 10V NHS South Eastern Hampshire CCG 4.1% 1.0%E10000032 West Sussex 99H NHS Surrey Downs CCG 0.6% 0.2%E09000033 Westminster 07P NHS Brent CCG 1.3% 2.0%E09000033 Westminster 07R NHS Camden CCG 3.0% 3.4%E09000033 Westminster 09A NHS Central London (Westminster) CCG 79.3% 71.3%E09000033 Westminster 08C NHS Hammersmith and Fulham CCG 0.6% 0.6%E09000033 Westminster 08K NHS Lambeth CCG 0.1% 0.2%E09000033 Westminster 08Y NHS West London (K&C & QPP) CCG 23.1% 22.6%E08000010 Wigan 00T NHS Bolton CCG 0.2% 0.1%E08000010 Wigan 01G NHS Salford CCG 0.8% 0.6%E08000010 Wigan 01X NHS St Helens CCG 3.8% 2.2%E08000010 Wigan 02E NHS Warrington CCG 0.4% 0.2%E08000010 Wigan 02G NHS West Lancashire CCG 2.8% 1.0%E08000010 Wigan 02H NHS Wigan Borough CCG 96.7% 95.7%E06000054 Wiltshire 11E NHS Bath and North East Somerset CCG 0.9% 0.4%E06000054 Wiltshire 15A NHS Berkshire West CCG 0.2% 0.2%E06000054 Wiltshire 15C NHS Bristol, North Somerset and South Gloucestershire CCG 0.2% 0.5%E06000054 Wiltshire 11J NHS Dorset CCG 0.3% 0.4%E06000054 Wiltshire 11M NHS Gloucestershire CCG 0.4% 0.5%E06000054 Wiltshire 11X NHS Somerset CCG 0.3% 0.4%E06000054 Wiltshire 12D NHS Swindon CCG 1.3% 0.6%E06000054 Wiltshire 11A NHS West Hampshire CCG 0.1% 0.2%E06000054 Wiltshire 99N NHS Wiltshire CCG 96.7% 96.8%E06000040 Windsor and Maidenhead 15A NHS Berkshire West CCG 0.4% 1.3%E06000040 Windsor and Maidenhead 14Y NHS Buckinghamshire CCG 0.3% 1.1%E06000040 Windsor and Maidenhead 15D NHS East Berkshire CCG 34.1% 96.9%E06000040 Windsor and Maidenhead 09Y NHS North West Surrey CCG 0.2% 0.5%E06000040 Windsor and Maidenhead 10Q NHS Oxfordshire CCG 0.0% 0.2%E06000040 Windsor and Maidenhead 10C NHS Surrey Heath CCG 0.1% 0.0%E08000015 Wirral 02F NHS West Cheshire CCG 0.4% 0.3%E08000015 Wirral 12F NHS Wirral CCG 99.7% 99.7%E06000041 Wokingham 15A NHS Berkshire West CCG 31.5% 97.0%E06000041 Wokingham 15D NHS East Berkshire CCG 1.0% 2.6%E06000041 Wokingham 10Q NHS Oxfordshire CCG 0.1% 0.4%E08000031 Wolverhampton 05C NHS Dudley CCG 1.3% 1.5%E08000031 Wolverhampton 05L NHS Sandwell and West Birmingham CCG 0.1% 0.3%E08000031 Wolverhampton 05Q NHS South East Staffs and Seisdon Peninsular CCG 1.8% 1.4%E08000031 Wolverhampton 05Y NHS Walsall CCG 3.4% 3.5%E08000031 Wolverhampton 06A NHS Wolverhampton CCG 93.8% 93.4%E10000034 Worcestershire 15E NHS Birmingham and Solihull CCG 0.9% 2.0%E10000034 Worcestershire 05C NHS Dudley CCG 0.7% 0.4%E10000034 Worcestershire 11M NHS Gloucestershire CCG 0.5% 0.6%E10000034 Worcestershire 05F NHS Herefordshire CCG 0.9% 0.3%E10000034 Worcestershire 05J NHS Redditch and Bromsgrove CCG 95.8% 27.7%E10000034 Worcestershire 05N NHS Shropshire CCG 0.3% 0.1%E10000034 Worcestershire 05R NHS South Warwickshire CCG 2.3% 1.1%E10000034 Worcestershire 05T NHS South Worcestershire CCG 97.2% 49.3%E10000034 Worcestershire 06D NHS Wyre Forest CCG 98.3% 18.6%E06000014 York 03E NHS Harrogate and Rural District CCG 0.2% 0.1%E06000014 York 03Q NHS Vale of York CCG 60.2% 99.9%Produced by NHS England using data from National Health Applications and Infrastructure Services (NHAIS) as supplied by NHS Digital.

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Better Care Fund 2019/20 Template1. Guidance

Overview

Note on entering information into this template

Throughout the template, cells which are open for input have a yellow background and those that are pre-populated have a grey background, as below:Data needs inputting in the cellPre-populated cellsNote on viewing the sheets optimallyFor a more optimal view each of the sheets and in particular the drop down lists clearly on screen, please change the zoom level between 90% - 100%. Most drop downs are also available to view as lists within the relevant sheet or in the guidance sheet for readability if required.

The details of each sheet within the template are outlined below.Checklist (click to go to Checklist, included in the Cover sheet)1. This section helps identify the data fields that have not been completed. All fields that appear as incomplete should be complete before sending to the Better Care Support Team.2. It is sectioned out by sheet name and contains the description of the information required, cell reference for the question and the 'checker' column which updates automatically as questions within each sheet are completed.3. The checker column will appear 'Red' and contain the word 'No' if the information has not been completed. Clicking on the corresponding 'Cell Reference' column will link to the incomplete cell for completion. Once completed the checker column will change to 'Green' and contain the word 'Yes'

4. The 'sheet completed' cell will update when all 'checker' values for the sheet are green containing the word 'Yes'.5. Once the checker column contains all cells marked 'Yes' the 'Incomplete Template' cell (below the title) will change to 'Complete Template'.6. Please ensure that all boxes on the checklist are green before submission.2. Cover (click to go to sheet)1. The cover sheet provides essential information on the area for which the template is being completed, contacts and sign off.

2. Question completion tracks the number of questions that have been completed; when all the questions in each section of the template have been completed the cell will turn green. Only when all cells are green should the template be sent to [email protected]. Please note that in line with fair processing of personal data we collect email addresses to communicate with key individuals from the local areas for various purposes relating to the delivery of the BCF plans including plan development, assurance, approval and provision of support. We remove these addresses from the supplied templates when they are collated and delete them when they are no longer needed. Please let us know if any of the submitted contact information changes during the BCF planning cycle so we are able to communicate with the right people in a timely manner.

4. Strategic Narrative (click to go to sheet)This section of the template should set out the agreed approach locally to integration of health & social care. The narratives should focus on updating existing plans, and changes since integration plans were set out until 2020 rather than reiterating them and can be short. Word limits have been applied to each section and these are indicated on the worksheet.

1. Approach to integrating care around the person. This should set out your approach to integrating health and social care around the people, particularly those with long term health and care needs. This should highlight developments since 2017 and cover areas such as prevention.

2 i. Approach to integrating services at HWB level (including any arrangements at neighbourhood level where relevant). This should set out the agreed approach and services that will be commissioned through the BCF. Where schemes are new or approaches locally have changed, you should set out a short rationale.2 ii. DFG and wider services. This should describe your approach to integration and joint commissioning/delivery with wider services. In all cases this should include housing, and a short narrative on use of the DFG to support people with care needs to remain independent through adaptations or other capital expenditure on their homes. This should include any discretionary use of the DFG.3. How your BCF plan and other local plans align with the wider system and support integrated approaches. Examples may include the read across to the STP (Sustainability Transformation Partnerships) or ICS (Integrated Care Systems) plan(s) for your area and any other relevant strategies.

You can attach (in the e-mail) visuals and illustrations to aid understanding if this will assist assurers in understanding your local approach.5. Income (click to go to sheet)

1. This sheet should be used to specify all funding contributions to the Health and Wellbeing Board's Better Care Fund (BCF) plan and pooled budget for 2019/20. On selected the HWB from the Cover page, this sheet will be pre-populated with the minimum CCG contributions to the BCF, DFG (Disabled Facilities Grant), iBCF (improved Better Care Fund) and Winter Pressures allocations to be pooled within the BCF. These cannot be edited.2. Please select whether any additional contributions to the BCF pool are being made from Local Authorities or the CCGs and as applicable enter the amounts in the fields highlighted in ‘yellow’. These will appear as funding sources when planning expenditure. The fields for Additional contributions can be utilised to include any relevant carry-overs from the previous year.3. Please use the comment boxes alongside to add any specific detail around this additional contribution including any relevant carry-overs assigned from previous years. All allocations are rounded to the nearest pound.4. For any questions regarding the BCF funding allocations, please contact [email protected]

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6. Expenditure (click to go to sheet)This sheet should be used to set out the schemes that constitute the BCF plan for the HWB including the planned expenditure and the attributes to describe the scheme. This information is then aggregated and utilised to analyse the BCF plans nationally and sets the basis for future reporting and to particularly demonstrate that National Condition 2 and 3 are met.

The table is set out to capture a range of information about how schemes are being funded and the types of services they are providing. There may be scenarios when several lines need to be completed in order to fully describe a single scheme or where a scheme is funded by multiple funding streams (eg: iBCF and CCG minimum). In this case please use a consistent scheme ID for each line to ensure integrity of aggregating and analysing schemes.On this sheet please enter the following information:1. Scheme ID:- This field only permits numbers. Please enter a number to represent the Scheme ID for the scheme being entered. Please enter the same Scheme ID in this column for any schemes that are described across multiple rows.2. Scheme Name: - This is a free field to aid identification during the planning process. Please use the scheme name consistently if the scheme is described across multiple lines in line with the scheme ID described above.3. Brief Description of Scheme- This is free text field to include a brief headline description of the scheme being planned.4. Scheme Type and Sub Type: - Please select the Scheme Type from the drop-down list that best represents the type of scheme being planned. A description of each scheme is available at the end of the table (follow the link to the description section at the top of the main expenditure table). - Where the Scheme Types has further options to choose from, the Sub Type column alongside will be editable and turn "yellow". Please select the Sub Type from the drop down list that best describes the scheme being planned.- Please note that the drop down list has a scroll bar to scroll through the list and all the options may not appear in one view.- If the scheme is not adequately described by the available options, please choose ‘Other’ and add a free field description for the scheme type in the column alongside.- While selecting schemes and sub-types, the sub-type field will be flagged in ‘red’ font if it is from a previously selected scheme type. In this case please clear the sub-type field and reselect from the dropdown if the subtype field is editable.5. Planned Outputs- The BCF Planning requirements document requires areas to set out planned outputs for certain scheme types (those which lend themselves to delivery of discrete units of delivery) to help to better understand and account for the activity funded through the BCF. - The Planned Outputs fields will only be editable if one of the relevant scheme types is selected. Please select a relevant unit from the drop down and an estimate of the outputs expected over the year. This is a numerical field.6. Metric Impact- This field is collecting information on the metrics that a chem will impact on (rather than the actual planned impact on the metric)- For the schemes being planned please select from the drop-down options of ‘High-Medium-Low-n/a’ to provide an indicative level of impact on the four BCF metrics. Where the scheme impacts multiple metrics, this can be expressed by selecting the appropriate level from the drop down for each of the metrics. For example, a discharge to assess scheme might have a medium impact on Delayed Transfers of Care and permanent admissions to residential care. Where the scheme is not expected to impact a metric, the ‘n/a’ option could be selected from the drop-down menu.7. Area of Spend:- Please select the area of spend from the drop-down list by considering the area of the health and social system which is most supported by investing in the scheme. - Please note that where ‘Social Care’ is selected and the source of funding is “CCG minimum” then the planned spend would count towards National Condition 2.- If the scheme is not adequately described by the available options, please choose ‘Other’ and add a free field description for the scheme type in the column alongside. - We encourage areas to try to use the standard scheme types where possible.8. Commissioner:- Identify the commissioning entity for the scheme based on who commissions the scheme from the provider. If there is a single commissioner, please select the option from the drop-down list. - Please note this field is utilised in the calculations for meeting National Condition 3.- If the scheme is commissioned jointly, please select ‘Joint’. Please estimate the proportion of the scheme being commissioned by the local authority and CCG/NHS and enter the respective percentages on the two columns alongside.9. Provider:- Please select the ‘Provider’ commissioned to provide the scheme from the drop-down list.- If the scheme is being provided by multiple providers, please split the scheme across multiple lines.

10. Source of Funding:- Based on the funding sources for the BCF pool for the HWB, please select the source of funding for the scheme from the drop-down list- If the scheme is funding across multiple sources of funding, please split the scheme across multiple lines, reflecting the financial contribution from each.11. Expenditure (£) 2019/20:- Please enter the planned spend for the scheme (or the scheme line, if the scheme is expressed across multiple lines)12. New/Existing Scheme- Please indicate whether the planned scheme is a new scheme for this year or an existing scheme being carried forward.

This is the only detailed information on BCF schemes being collected centrally for 2019/20 and will inform the understanding of planned spend for the iBCF and Winter Funding grants.

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7. HICM (click to go to sheet)National condition four of the BCF requires that areas continue to make progress in implementing the High Impact Change model for managing transfers of care and continue to work towards the centrally set expectations for reducing DToC. In the planning template, you should provide:- An assessment of your current level of implementation against each of the 8 elements of the model – from a drop-down list- Your planned level of implementation by the end March 2020 – again from a drop-down listA narrative that sets out the approach to implementing the model further. The Narrative section in the HICM tab sets out further details.8. Metrics (click to go to sheet)This sheet should be used to set out the Health and Wellbeing Board's performance plans for each of the Better Care Fund metrics in 2019/20. The BCF requires plans to be agreed for the four metrics. This should build on planned and actual performance on these metrics in 2018/19.1. Non-Elective Admissions (NEA) metric planning:- BCF plans as in previous years mirror the latest CCG Operating Plans for the NEA metric. Therefore, this metric is not collected via this template.2. Residential Admissions (RES) planning: - This section requires inputting the information for the numerator of the measure.- Please enter the planned number of council-supported older people (aged 65 and over) whose long-term support needs will be met by a change of setting to residential and nursing care during the year (excluding transfers between residential and nursing care) for the Residential Admissions numerator measure.- The prepopulated denominator of the measure is the size of the older people population in the area (aged 65 and over) taken from ONS subnational population projections.- The annual rate is then calculated and populated based on the entered information.- Please include a brief narrative associated with this metric plan3. Reablement (REA) planning: - This section requires inputting the information for the numerator and denominator of the measure.- Please enter the planned denominator figure, which is the planned number of older people discharged from hospital to their own home for rehabilitation (or from hospital to a residential or nursing care home or extra care housing for rehabilitation, with a clear intention that they will move on/back to their own home).- Please then enter the planned numerator figure, which is the planned number of older people discharged from hospital to their own home for rehabilitation (from within the denominator) that will still be at home 91 days after discharge.- The annual proportion (%) Reablement measure will then be calculated and populated based on this information.- Please include a brief narrative associated with this metric plan4. Delayed Transfers of Care (DToC) planning: - The expectations for this metric from 2018/19 are retained for 2019/20 and these are prepopulated. - Please include a brief narrative associated with this metric plan. - This narrative should include details of the plan, agreed between the local authority and the CCG for using the Winter Pressures grant to manage pressures on the system over Winter.9. Planning Requirements (click to go to sheet)This sheet requires the Health & Wellbeing Board to confirm whether the National Conditions and other Planning Requirements detailed in the BCF Policy Framework and the BCF Requirements document are met. Please refer to the BCF Policy Framework and BCF Planning Requirements documents for 2019/20 for further details.The Key Lines of Enquiry (KLOE) underpinning the Planning Requirements are also provided for reference as they will be utilised to assure plans by the regional assurance panel.1. For each Planning Requirement please select ‘Yes’ or ‘No’ to confirm whether the requirement is met for the BCF Plan.2. Where the confirmation selected is ‘No’, please use the comments boxes to include the actions in place towards meeting the requirement and the target timeframes.10. CCG-HWB Mapping (click to go to sheet)

The final sheet provides details of the CCG - HWB mapping used to calculate contributions to Health and Wellbeing Board level non-elective activity figures.

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Version 0.1

Please Note:

Yes19/09/2019

Professional Title (where applicable) First-name: Surname: E-mail:

*Area Assurance Contact Details:Councillor Hazel Simonds

Luton CCG Accountable

Nicky Poulain [email protected]

N/A N/A N/A N/A

Luton Borough Council Chief

Robin Porter [email protected]

Corporate Director Public

Gerry Taylor [email protected]

Programme Manager Health

Kate Sutherland [email protected]

Service Director Finance, Audit &

Dev Gopal [email protected]

Please add further area contacts that you would wish to be included in

official correspondence -->

Role:Health and Wellbeing Board Chair

Clinical Commissioning Group Accountable Officer (Lead)

Additional Clinical Commissioning Group(s) Accountable Officers

Local Authority Chief Executive

Local Authority Director of Adult Social Services (or equivalent)

Better Care Fund Lead Official

LA Section 151 Officer

Who signed off the report on behalf of the Health and Wellbeing Board:

Better Care Fund 2019/20 Template2. Cover

Kate Sutherland

[email protected]

Luton

01582 548438

Health and Wellbeing Board:

Completed by:

E-mail:

Contact number:

- You are reminded that much of the data in this template, to which you have privileged access, is management information only and is not in the public domain. It is not to be shared more widely than is necessary to complete the return.- Please prevent inappropriate use by treating this information as restricted, refrain from passing information on to others and use it only for the purposes for which it is provided. Any accidental or wrongful release should be reported immediately and may lead to an inquiry. Wrongful release includes indications of the content, including such descriptions as "favourable" or "unfavourable".- Please note that national data for plans is intended for release in aggregate form once plans have been assured, agreed and baselined as per the due process outlined in the BCF Planning Requirements for 2019/20.- This template is password protected to ensure data integrity and accurate aggregation of collected information. A resubmission may be required if this is breached.

Nicky Poulain, CCG Accountable Officer, Gerry Taylor, LBC Corpora


*Only those identified will be addressed in official correspondence (such as approval letters). Please ensure all individuals are satisfied with the information entered above as this is exactly how they will appear in correspondence.

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Complete:2. Cover No4. Strategic Narrative No5. Income Yes6. Expenditure No7. HICM No8. Metrics No9. Planning Requirements No

2. Cover ^^ Link back to topCell Reference CheckerD13 YesD15 YesD17 YesD19 YesD21 YesD23 YesD24 YesC27 : C36 YesF27 : F36 YesG27 : G36 YesH27 : H36 No

No

4. Strategic Narrative ^^ Link back to topCell Reference CheckerB20 NoB31 NoB37 NoB44 No

No

5. Income ^^ Link back to topCell Reference CheckerC39 YesB42 : B44 YesC42 : C44 YesD42 : D44 YesC59 YesB62 : B71 YesC62 : C71 YesD62 : D71 Yes

Yes

Area Assurance Contact Details - First name:Area Assurance Contact Details - Surname:

Sheet Complete

Are any additional CCG Contributions being made in 2019/20?Additional CCGsAdditional CCG Contribution

Area Assurance Contact Details - E-mail:

Are any additional LA Contributions being made in 2019/20?

C) System level alignment:

<< Link to the Guidance sheet

Checklist

A) Person-centred outcomes:B) (i) Your approach to integrated services at HWB level (and neighbourhood where applicable):B) (ii) Your approach to integration with wider services (e.g. Housing):

Question Completion - when all questions have been answered and the validation boxes below have turned green you should send the template to [email protected] saving the file as 'Name HWB' for example 'County Durham HWB'

Contact number:Who signed off the report on behalf of the Health and Wellbeing Board:

Sheet Complete

Please see the Checklist below for further details on incomplete fields

Health & Wellbeing BoardCompleted by:E-mail:

Area Assurance Contact Details - Role:

Additional CCG Contribution Narrative

Sheet Complete

Additional Local AuthorityAdditional LA ContributionAdditional LA Contribution Narrative


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6. Expenditure ^^ Link back to topCell Reference CheckerB22 : B271 YesC22 : C271 YesD22 : D271 YesE22 : E271 YesF22 : F271 YesG22 : G271 YesH22 : H271 NoI22 : I271 YesJ22 : J271 YesK22 : K271 YesL22 : L271 YesM22 : M271 YesN22 : N271 YesO22 : O271 YesP22 : P271 YesQ22 : Q271 YesS22 : S271 YesT22 : T271 YesU22 : U271 YesV22 : V271 Yes

No

7. HICM ^^ Link back to topCell Reference CheckerB11 NoD15 NoD16 NoD17 NoD18 NoD19 NoD20 NoD21 NoD22 NoE15 NoE16 NoE17 NoE18 NoE19 NoE20 NoE21 NoE22 NoF15 YesF16 YesF17 YesF18 YesF19 YesF20 YesF21 YesF22 Yes

No

Chg 7) Focus on choice - Current Level:Chg 8) Enhancing health in care homes - Current Level:

Provider:Source of Funding:Expenditure:New/Existing Scheme:

Sheet Complete

Impact: Reablement:Area of Spend:Specify if area of spend is Other:Commissioner:Joint Commissioner %:

Planned Output:Planned Output Unit Estimate:

Scheme ID:

Chg 1) Early discharge planning - Current Level:Chg 2) Systems to monitor patient flow - Current Level:Chg 3) Multi-disciplinary/Multi-agency discharge teams - Current Level:Chg 4) Home first / discharge to assess - Current Level:Chg 5) Seven-day service - Current Level:Chg 6) Trusted assessors - Current Level:

Impact: Delayed Transfers of Care:Impact: Residential Admissions:

Sub Types:

Scheme Name:Brief Description of Scheme:Scheme Type:

Specify if scheme type is Other:

Impact: Non-Elective Admissions:

Priorities for embedding elements of the HCIM for Managing Transfers of Care locally:

Chg 1) Early discharge planning - Planned Level:Chg 2) Systems to monitor patient flow - Planned Level:Chg 3) Multi-disciplinary/Multi-agency discharge teams - Planned Level:Chg 4) Home first / discharge to assess - Planned Level:Chg 5) Seven-day service - Planned Level:Chg 6) Trusted assessors - Planned Level:Chg 7) Focus on choice - Planned Level:Chg 8) Enhancing health in care homes - Planned Level:

Sheet Complete

Chg 1) Early discharge planning - Reasons:Chg 2) Systems to monitor patient flow - Reasons:Chg 3) Multi-disciplinary/Multi-agency discharge teams - Reasons:Chg 4) Home first / discharge to assess - Reasons:Chg 5) Seven-day service - Reasons:Chg 6) Trusted assessors - Reasons:Chg 7) Focus on choice - Reasons:Chg 8) Enhancing health in care homes - Reasons:

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8. Metrics ^^ Link back to topCell Reference CheckerE10 NoE17 NoF27 NoG26 NoF39 NoF40 NoG38 No

No

9. Planning Requirements ^^ Link back to topCell Reference CheckerF8 NoF9 NoF10 NoF11 YesF12 YesF13 NoF14 NoF15 NoF16 NoH8 YesH9 YesH10 YesH11 YesH12 YesH13 YesH14 YesH15 YesH16 YesI8 YesI9 YesI10 YesI11 YesI12 YesI13 YesI14 YesI15 YesI16 Yes

No

^^ Link back to top

Non-Elective Admissions: Overview Narrative:Delayed Transfers of Care: Overview Narrative:Residential Admissions Numerator:Residential Admissions: Overview Narrative:Reablement Numerator:

Sheet Complete

PR5: NC3: NHS commissioned Out of Hospital Services - Actions in place if not

PR2: NC1: Jointly agreed plan - Timeframe if not metPR3: NC1: Jointly agreed plan - Timeframe if not metPR4: NC2: Social Care Maintenance - Timeframe if not metPR5: NC3: NHS commissioned Out of Hospital Services - Timeframe if not metPR6: NC4: Implementation of the HICM for Managing Transfers of Care - Timeframe if not metPR7: Agreed expenditure plan for all elements of the BCF - Timeframe if not metPR8: Agreed expenditure plan for all elements of the BCF - Timeframe if not metPR9: Metrics - Timeframe if not met

PR1: NC1: Jointly agreed plan - Actions in place if notPR2: NC1: Jointly agreed plan - Actions in place if not

PR1: NC1: Jointly agreed plan - Plan to Meet

PR6: NC4: Implementation of the HICM for Managing Transfers of Care - Actions in place if notPR7: Agreed expenditure plan for all elements of the BCF - Actions in place if notPR8: Agreed expenditure plan for all elements of the BCF - Actions in place if notPR9: Metrics - Actions in place if notPR1: NC1: Jointly agreed plan - Timeframe if not met

PR3: NC1: Jointly agreed plan - Actions in place if notPR4: NC2: Social Care Maintenance - Actions in place if not

PR2: NC1: Jointly agreed plan - Plan to MeetPR3: NC1: Jointly agreed plan - Plan to MeetPR4: NC2: Social Care Maintenance - Plan to MeetPR5: NC3: NHS commissioned Out of Hospital Services - Plan to MeetPR6: NC4: Implementation of the HICM for Managing Transfers of Care - Plan to MeetPR7: Agreed expenditure plan for all elements of the BCF - Plan to MeetPR8: Agreed expenditure plan for all elements of the BCF - Plan to MeetPR9: Metrics - Plan to Meet

Reablement Denominator:Reablement: Overview Narrative:

Sheet Complete

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Income Expenditure Difference£1,417,554 £1,417,554 £0

£13,888,448 £13,888,448 £0£6,472,833 £6,472,833 £0

£788,125 £788,125 £0£0 £0 £0£0 £0 £0

£22,566,960 £22,566,960 £0

£3,946,703£7,266,838

£6,344,639£6,655,752

£1,217,518£356,265£128,799

£4,143,475£2,354,022

£433,826£2,365,386

£957,541£75,500

£1,835,668£1,707,196

£225,000£0

£714,127£1,028,384£5,024,252

£22,566,959

Income & Expenditure


NHS Commissioned Out of Hospital spend from the minimum CCG allocation

Funding Sources

Income >>

Total

Planned spend

Minimum required spendPlanned spend

Assistive Technologies and EquipmentCare Act Implementation Related Duties

Scheme Types

Other


Adult Social Care services spend from the minimum CCG allocations

Carers ServicesCommunity Based SchemesDFG Related SchemesEnablers for IntegrationHICM for Managing Transfer of CareHome Care or Domiciliary CareHousing Related Schemes

Expenditure >>

Integrated Care Planning and NavigationIntermediate Care ServicesPersonalised Budgeting and Commissioning

Better Care Fund 2019/20 Template3. Summary

DFGMinimum CCG ContributioniBCFWinter Pressures GrantAdditional LA ContributionAdditional CCG Contribution

Total

Minimum required spend

Prevention / Early InterventionResidential Placements

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Chg 1 Early discharge planning

Chg 2 Systems to monitor patient flow

Chg 3Multi-disciplinary/Multi-agency discharge teams

Chg 4 Home first / discharge to assess

Chg 5 Seven-day service

Chg 6 Trusted assessors

Chg 7 Focus on choice

Chg 8 Enhancing health in care homes

19/20 Plan

Annual Rate 0

19/20 Plan

Annual (%)

Theme Code Response

PR1

PR2

PR3

PR4 Yes

PR5 Yes

PR6

PR7

PR8

PR9

Planned level of maturity for 2019/2020

Go to Better Care Exchange >>

Metrics

HICM >>

Planning Requirements >>

Reablement

Residential Admissions

Non-Elective AdmissionsDelayed Transfer of Care




Metrics >>





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https://future.nhs.uk/connect.ti/bettercareexchange/view?objectId=51593157


Please outline your approach towards integration of health & social care:

Link to B) (i)Link to B) (ii)Link to C)

Remaining Word Limit: 1500

Better Care Fund 2019/20 Template4. Strategic Narrative

- Prevention and self-care- Promoting choice and independence

When providing your responses to the below sections, please highlight any learning from the previous planning round (2017-2019) and cover any priorities for reducing health inequalities under the Equality Act 2010.

A) Person-centred outcomesYour approach to integrating care around the person, this may include (but is not limited to):

Please note that there are 4 responses required below, for questions: A), B(i), B(ii) and C)

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- Joint commissioning arrangements

B) HWB level

- Alignment with primary care services (including PCNs (Primary Care Networks))- Alignment of services and the approach to partnership with the VCS (Voluntary and Community Sector)

(i) Your approach to integrated services at HWB level (and neighbourhood where applicable), this may include (but is not limited to):

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- Your approach to using the DFG to support the housing needs of people with disabilities or care needs. This should include any arrangements for strategic planning for the use of adaptations and technologies to support independent living in line with the

(ii) Your approach to integration with wider services (e.g. Housing), this should include:

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C) System level alignment, for example this may include (but is not limited to):- How the BCF plan and other plans align to the wider integration landscape, such as STP/ICS plans- A brief description of joint governance arrangements for the BCF plan

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Disabled Facilities Grant (DFG) Gross Contribution

Luton £1,417,554

123456789

101112

Total Minimum LA Contribution (exc iBCF) £1,417,554

iBCF Contribution ContributionLuton £6,472,833

Total iBCF Contribution £6,472,833

Winter Pressures Grant ContributionLuton £788,125

Total Winter Pressures Grant Contribution £788,125

Are any additional LA Contributions being made in 2019/20? If yes, please detail below No

Local Authority Additional Contribution Contribution

Total Additional Local Authority Contribution £0

Better Care Fund 2019/20 Template5. Income

DFG breakerdown for two-tier areas only (where applicable)

Local Authority Contribution


Luton

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CCG Minimum Contribution Contribution1 NHS Luton CCG £13,888,448234567

Total Minimum CCG Contribution £13,888,448

Are any additional CCG Contributions being made in 2019/20? If yes, please detail below No

Additional CCG Contribution Contribution

Total Addition CCG Contribution £0Total CCG Contribution £13,888,448

2019/20Total BCF Pooled Budget £22,566,960

Funding Contributions CommentsOptional for any useful detail e.g. Carry overThe above plan assumes the receives the additional allocation notified by NHSE. If that allocation is not received, then the contribution to social care will reduce accordingly.


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Link to Scheme Type descriptionScheme

IDScheme Name Brief Description of

SchemeScheme Type Sub Types Please specify if

'Scheme Type' is 'Other'

Planned Output Unit

Planned Output

Estimate

NEA DTOC RES REA Area of Spend

Please specify if 'Area of Spend'

is 'other'

Commissioner % NHS (if Joint Commissioner)

% LA (if Joint Commissioner)

Provider Source of Funding

Expenditure (£) New/ Existing Scheme

1 Joint Commissioning: Mental Health Contract

Joint Commissioning: Mental Health Contract


Not applicable

Not applicable

Not applicable

Not applicable

Mental Health

CCG NHS Mental Health Provider

Minimum CCG Contribution

£1,414,020 Existing

2 HICM: Acute Commuity Care Team HICM: Acute Commuity Care Team


Not applicable

Medium Not applicable

Not applicable

Community Health

CCG NHS Community Provider


£367,969 Existing

2 HICM: Co-ordinating Provider role HICM: Co-ordinating Provider role


Not applicable


Not applicable

Community Health



£129,871 Existing

2 HICM: Integrated Discharge Team HICM: Integrated Discharge Team


Not applicable


Not applicable

Community Health



£444,243 Existing

2 HICM: Nursing Co-ordinators in CCS (MDT Co-ordinators)

HICM: Nursing Co-ordinators in CCS (MDT Co-ordinators)


Not applicable


Not applicable

Community Health



£248,405 Existing

3 Rapid Response Rapid Response Community Based Schemes

High Not applicable

Not applicable

Not applicable

Community Health



£225,823 Existing

4 EOL: Cancer & Palliative Care EOL: Cancer & Palliative Care


Low Not applicable

Not applicable

Not applicable

Community Health




5 FallsPrevention: Co-ordinator in CCS FallsPrevention: Co-ordinator in CCS


Low Not applicable

Not applicable

Not applicable

Community Health



£179,346 Existing

6 Intermediate Care Intermediate Care Intermediate Care Services

Reablement/Rehabilitation Services

Not applicable

Not applicable

Not applicable

High Community Health

CCG Private Sector



7 Joint Commissioning: Meet and Greet Service for Carers

Joint Commissioning: Meet and Greet Service for Carers

Carers Services Carer Advice and Support

Not applicable

Not applicable

Not applicable

Not applicable

Other Charity / Voluntary Sector

CCG Charity / Voluntary Sector


£128,799 Existing

8 Care Act Reforms Care Act Reforms Care Act Implementation Related Duties

Other Care Act duties Not applicable

Not applicable

Not applicable

Not applicable

Social Care LA Local Authority


£356,265 Existing

9 Rehabilitation & support for the Discharge Team

Rehabilitation & support for the Discharge Team

HICM for Managing Transfer of Care

Chg 1. Early Discharge Planning

Not applicable

Not applicable

Not applicable

High Social Care LA Private Sector


£457,281 Existing

9 Development of GP cluster model - care management

Development of GP cluster model - care management


Chg 3. Multi-Disciplinary/Multi-Agency Discharge

High High Not applicable

Not applicable



£249,426 Existing

9 Re-ablement Team Restructure to clusters Re-ablement Team Restructure to clusters


Chg 3. Multi-Disciplinary/Multi-Agency Discharge

Not applicable

High Not applicable

High Social Care LA Local Authority


£101,790 Existing

9 Reablement: Stepdown reablement flat Reablement: Stepdown reablement flat


Chg 4. Home First / Discharge to Access

Not applicable

High Not applicable



£81,432 Existing

9 Reablement: Reablement Team (to better support seven day discharges)

Reablement: Reablement Team (to better support seven


Chg 5. Seven-Day Services

Not applicable

High Not applicable



£207,855 Existing

BalanceIncome Expenditure£1,417,554

£13,888,448£6,472,833

<< Link to summary sheetRunning Balances

DFGMinimum CCG ContributioniBCF

£0£0£0

£1,417,554£13,888,448

£6,472,833

£0£788,125Winter Pressures Grant £0£788,125

£0£0

£6,344,639

£7,266,838

£6,655,752

£0

£0

Required SpendNHS Commissioned Out of Hospital spend from the minimum CCG allocationAdult Social Care services spend from the minimum CCG allocations

Minimum Required Spend Planned Spend Under Spend

Better Care Fund 2019/20 Template6. Expenditure

ExpenditurePlanned Outputs Metric Impact

£0£0

£22,566,960

£0

Luton

Additional LA ContributionAdditional CCG Contribution

Total


£3,946,703

£0£22,566,960

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10 Learning Disabilities - supporting adult social care

Learning Disabilities - supporting adult social care


Learning Disability Placements 13.0 Medium Medium Medium Medium Social Care LA Private Sector


£719,869 Existing

10 Mental Health - supporting adult social care Mental Health - supporting adult social care


Supported Living Placements 9.0 Medium Medium Medium Medium Social Care LA Private Sector


£308,515 Existing

10 Older People - supporting adult social care Older People - supporting adult social care


Hours of Care 63,000.0 Medium Medium Medium Medium Social Care LA Private Sector


£957,541 Existing

10 Care management - supporting adult social care

Care management - supporting adult social care

Integrated Care Planning and Navigation

Care Planning, Assessment and Review

Medium Medium Medium Medium Social Care LA Local Authority


£752,432 Existing

11 Joint Autism Strategy Joint Autism Strategy Integrated Care Planning and Navigation


Not applicable

Not applicable

Low Not applicable



£20,358 Existing

10 DTOC: Social Care Staff in DART to facilitate hospital discharge

DTOC: Social Care Staff in DART to facilitate hospital discharge



Not applicable

High Not applicable

Not applicable



£103,826 Existing

10 DTOC: Hospital Discharge Initiatives continuation

DTOC: Hospital Discharge Initiatives continuation



Not applicable

High Not applicable

Not applicable



£133,650 Existing

11 IPC: Dementia Advisors (Alzheimers Society) IPC: Dementia Advisors (Alzheimers Society)


Social Prescribing Medium Not applicable

Low Not applicable

Social Care LA Charity / Voluntary Sector


£69,217 Existing

12 Wellbeing: Community Based Prevention Wellbeing: Community Based Prevention



Low Not applicable



£164,493 Existing

12 Wellbeing: Wellbeing projects continuation Wellbeing: Wellbeing projects continuation



Not applicable

Not applicable

Social Care LA Charity / Voluntary Sector


£77,360 Existing

13 Joint Commissioning: Programme Costs Joint Commissioning: Programme Costs


Implementation & Change Mgt capacity

Not applicable

Not applicable

Not applicable

Not applicable



£103,826 Existing

14 LD Project Manager Transforming Care • Housing Plan• Risk management• Luton Steering Group



Not applicable

Not applicable

Low Not applicable



£57,000 Existing

80 Disabled Facilities Grant (DFG) Disabled Facilities Grant (DFG)

DFG Related Schemes

Adaptations Low Low Not applicable

Medium Social Care LA Local Authority

DFG £1,417,554 Existing


Equipment and adaptations: Community Equipment Services

Assistive Technologies and Equipment

Community Based Equipment

Medium High Low Medium Social Care LA Private Sector


£567,734 Existing


Equipment and adaptations: Community Equipment Services


Community Based Equipment

Not applicable

Not applicable

Low Medium Other Social Care CCG Private Sector


£567,734 Existing

15 Telecare Telecare Assistive Technologies and Equipment

Telecare Medium High Low High Social Care LA Private Sector


£72,271 Existing

15 Equipment and adaptations: Adaptations & Minor Works

Equipment and adaptations: Adaptations & Minor

DFG Related Schemes

Adaptations Medium Medium Low Medium Social Care LA Private Sector


£936,468 Existing

16 Social Prescription to design the preferred holistic social prescription model for



Not applicable

Not applicable



£100,000 Existing

17 STEPS The Steps service assesses and supports individuals within the



Not applicable

High Not applicable

Not applicable

Social Care CCG Local Authority


£34,142 Existing

18 AMP Support/Training AMP Support/Training Integrated Care Planning and Navigation


Not applicable

Not applicable

Not applicable

Medium Social Care LA Local Authority


£23,000 New

19 Falls Prevention: Falls Scheme The overarching aim is to develop a clear integrated falls pathway,


Other training of client

Low Not applicable

Not applicable

Not applicable

Community Health



£117,886 Existing

20 EOL: End of Life Schemes The main aim of the project is to improve multi-agency


Other training of staff Low Not applicable

Not applicable

Not applicable

Community Health



£50,171 New

21 Early Supported Discharge Strokes Early Supported Discharge Strokes


Chg 4. Home First / Discharge to Access

Not applicable


Not applicable

Community Health

CCG Private Sector


£305,000 New

22 BLMK Transforming Care PM (1/3 FTE) BLMK Transforming Care PM (1/3 FTE)



Not applicable

Not applicable


Other CCG CCG CCG Minimum CCG Contribution

£16,000 Existing

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999 BCF Contingency BCF Contingency Other contingency Not applicable

Not applicable

Not applicable

Not applicable


£30,037 Existing

51 Energy Doctor in the Home (preventative Technology)

The scheme aims to: • to reduce levels of fuel poverty


Other energy doctor Low Low Low Low social care LA Local Authority

iBCF £55,000 Existing

52 Enabling Change - Systems integration, technology website change and population management

Deliver system integration and improve digital experience,


Shared records and Interoperability

Not applicable

Not applicable

Not applicable

Not applicable

social care LA Local Authority


53 Population Management and Self Care Project

Population Management and Self Care Project



Not applicable

Not applicable



54 Side by Side Nationally people are living longer, have multiple long term



Medium Medium Medium Medium social care LA Local Authority


55 Enhanced Health in Care Homes -> Over 65s/carehome

The main aim of this work programme is to reduce the need for


Other training of staff High Not applicable

Not applicable

Not applicable

Community Health

CCG Private sector


56 Direct payment/Social Work Resources to support in community

The use of DPs has been promoted by Government under the


Integrated Personalised Commissioning

Not applicable

Not applicable

Not applicable

Not applicable



57 Integrated IAG model Integration of more IAG services into our Luton Access Model that


Single Point of Access

Low Not applicable

Not applicable

Not applicable



58 Housing First We will be focusing on individuals that have a high level of no elective


Low Not applicable

Not applicable

Low social care LA Local Authority


59 iBCF Programme Support, System Integration & Restorative Practice

iBCF Programme Support, System Integration &


Implementation & Change Mgt capacity

Not applicable

Not applicable

Not applicable

Not applicable



60 Community Learning Disability Team (2 nurses)

This project will enable the Community Learning Disability Team (CLDT) is



Medium Medium Medium Not applicable


iBCF £78,000 New

61 Housing ATS Telehealth (overrun into April-June)

Housing ATS Telehealth (overrun into April-June)


Telecare Low Not applicable

Not applicable

Not applicable



999 iBCF Contingency iBCF Contingency Other contingency Not applicable

Not applicable

Not applicable

Not applicable



62 Meeting ASC growing needs Meeting ASC growing needs

Other meeting ASC growing needs

High High High Medium social care LA Local Authority

iBCF £1,971,833 Existing

63 Suporting the care provider market Suporting the care provider market

Other supporting care market

Medium Medium Medium Medium social care LA Local Authority

iBCF £2,305,000 Existing

71 Homecare Homecare HICM for Managing Transfer of Care


Medium High Not applicable

Not applicable


Winter Pressures Grant

£410,125 New

72 Short stay mental health Short stay mental health HICM for Managing Transfer of Care


Medium High Not applicable

Not applicable



£315,000 New

73 Reviewing staff Reviewing staff Integrated Care Planning and Navigation


Not applicable

Low Not applicable

Not applicable



£63,000 New

23 LCCG spend reallocation to BCF for a 6.1% minimum contribution

LCCG reallocation to BCF Other to satisfy the 6.1% minimum contribution

Not applicable

Not applicable

Not applicable

Not applicable


£564,573 New

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Funding planned towards the implementation of Care Act related duties.Supporting people to sustain their role as carers and reduce the likelihood of crisis. Advice, advocacy, information, assessment, emotional and physical support, training, access to services to support wellbeing and improve independence. This also includes the implementation of the Care Act as a sub-type.Schemes that are based in the community and constitute a range of cross sector practitioners delivering collaborative services in the community typically at a neighbourhood level (eg: Integrated Neighbourhood Teams)The DFG is a means-tested capital grant to help meet the costs of adapting a property; supporting people to stay independent in their own homes.

Using technology in care processes to supportive self-management, maintenance of independence and more efficient and effective delivery of care. (eg. Telecare, Wellness services, Digital participation services).

DescriptionScheme TypeAssistive Technologies and Equipment

Care Act Implementation Related Duties

Carers Services


DFG Related Schemes

Sub TypeTelecareWellness ServicesDigital Participation ServicesCommunity Based EquipmentOthDeprivation of Liberty Safeguards (DoLS)OtherCarer Advice and SupportRespite ServicesOther

AdaptationsOther

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High Impact Change Model for Managing Transfer of Care



Schemes that build and develop the enabling foundations of health and social care integration encompassing a wide range of potential areas including technology, workforce, market development (Voluntary Sector Business Development: Funding the business development and preparedness of local voluntary sector into provider Alliances/ Collaboratives) and programme management related schemes. Joint commissioning infrastructure includes any personnel or teams that enable joint commissioning. Schemes could be focused on Data Integration, System IT Interoperability, Programme management, Research and evaluation, Supporting the Care Market, Workforce development, Community asset mapping, New governance arrangements, Voluntary Sector Development, Employment services, J i t i i i i f t t t thThe eight changes or approaches identified as having a high impact on supporting timely and effective discharge through joint working across the social and health system. The Hospital to Home Transfer Protocol or the 'Red Bag' scheme, while not in the HICM as such, is included in this section.

A range of services that aim to help people live in their own homes through the provision of domiciliary care including personal care, domestic tasks, shopping, home maintenance and social activities. Home care can link with other services in the community, such as supported housing, community health services and voluntary sector services.

This covers expenditure on housing and housing-related services other than adaptations; eg: supported housing units.

Chg 1. Early Discharge PlanningChg 2. Systems to Monitor Patient FlowChg 3. Multi-Disciplinary/Multi-Agency Discharge TeamsChg 4. Home First / Discharge to AccessChg 5. Seven-Day ServicesChg 6. Trusted AssessorsChg 7. Focus on ChoiceChg 8. Enhancing Health in Care HomesOther - 'Red Bag' schemeOther approaches

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Short-term intervention to preserve the independence of people who might otherwise face unnecessarily prolonged hospital stays or avoidable admission to hospital or residential care. The care is person-centred and often delivered by a combination of professional groups. Four service models of intermediate care are: bed-based intermediate care, crisis or rapid response (including falls), home-based intermediate care, and reablement or rehabilitation. Home-based intermediate care is covered in Scheme-A and the other three models are available on the sub-types.


Care navigation services help people find their way to appropriate services and support and consequently support self-management. Also, the assistance offered to people in navigating through the complex health and social care systems (across primary care, community and voluntary services and social care) to overcome barriers in accessing the most appropriate care and support. Multi-agency teams typically provide these services which can be online or face to face care navigators for frail elderly, or dementia navigators etc. This includes approaches like Single Point of Access (SPoA) and linking people to community assets.Integrated care planning constitutes a co-ordinated, person centred and proactive case management approach to conduct joint assessments of care needs and develop integrated care plans typically carried out by professionals as part of a multi-disciplinary, multi-agency teams. Note: For Multi-Disciplinary Discharge Teams and the HICM for managing discharges, please select HICM as scheme type and the relevant sub-type. Where the planned unit of care delivery and funding is in the form of Integrated care packages and needs to be expressed in such a manner please select the appropriate sub type alongside

Integrated Care Planning and Navigation Care CoordinationSingle Point of AccessCare Planning, Assessment and ReviewOther

Bed Based - Step Up/DownRapid / Crisis ResponseReablement/Rehabilitation ServicesOther

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Various person centred approaches to commissioning and budgeting.

Schemes specifically designed to ensure that a person can continue to live at home, through the provision of health related support at home often complemented with support for home care needs or mental health needs. This could include promoting self-management/expert patient, establishment of ‘home ward’ for intensive period or to deliver support over the longer term to maintain independence or offer end of life care for people. Intermediate care services provide shorter term support and care interventions as opposed to the ongoing support provided in this scheme type.

Services or schemes where the population or identified high-risk groups are empowered and activated to live well in the holistic sense thereby helping prevent people from entering the care system in the first place. These are essentially upstream prevention initiatives to promote independence and well being.Residential placements provide accommodation for people with learning or physical disabilities, mental health difficulties or with sight or hearing loss, who need more intensive or specialised support than can be provided at home.


Where the scheme is not adequately represented by the above scheme types, please outline the objectives and services planned for the scheme in a short description in the comments column.

Other

Personal Health BudgetsIntegrated Personalised CommissioningDirect PaymentsOther

Social PrescribingRisk StratificationChoice PolicyOther

Supported LivingLearning DisabilityExtra CareCare HomeNursing HomeOther

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Please enter current position of maturity

Please enter the maturity level planned to be reached by March 2020

If the planned maturity level for 2019/20 is below established, please state reasons behind that?

Chg 1Early discharge planning

<Please select> <Please select>

Chg 2Systems to monitor patient flow <Please select> <Please select>

Chg 3Multi-disciplinary/Multi-agency discharge teams <Please select> <Please select>

Chg 4Home first / discharge to assess <Please select> <Please select>

Chg 5Seven-day service


Chg 6Trusted assessors


Chg 7Focus on choice


Chg 8Enhancing health in care homes <Please select> <Please select>

Better Care Fund 2019/20 Template7. High Impact Change Model

Luton

- The changes that you are looking to embed further - including any changes in the context of commitments to reablement and Enhanced Health in Care Homes in the NHS Long-Term Plan

Explain your priorities for embedding elements of the High Impact Change Model for Managing Transfers of Care locally, including:- Current performance issues to be addressed

- Anticipated improvements from this work

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Total number of specific acute non-elective spells per 100,000 population

Please set out the overall plan in the HWB area for reducing Non-Elective Admissions, including any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric.

19/20 Plan

3.9

Please set out the overall plan in the HWB area for reducing Delayed Transfers of Care to meet expectations set for your area. This should include any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric. Include in this, your agreed plan for using the Winter Pressures grant funding to support the local health and care system to manage demand pressures on the NHS, with particular reference to seasonal winter pressures.


Delayed Transfers of Care per day (daily delays) from hospital (aged 18+)

Overview Narrative

8.1 Non-Elective Admissions

Please note that the plan figure for Greater Manchester has been combined, for HWBs in Greater Manchester please comment on individuals HWBs rather than Greater Manchester as a whole.

Better Care Fund 2019/20 Template8. Metrics

8.2 Delayed Transfers of Care

Please note that due to the merger of Bournemouth, Christchurch and Poole to a new Local Authority will mean that planning information from 2018/19 will not reflect the present geographies.

Overview Narrative19/20 Plan

Collection of the NEA metric plans via this template is not required as the BCF NEA metric plans are based on the NEA CCG Operating plans submitted via SDCS.

Plans are yet to be finalised and signed-off so are subject to change; for the latest version of the NEA CCG operating plans at your HWB footprint please contact your local Better Care Manager (BCM) in the first instance or write in to the support inbox:[email protected]

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18/19 Plan 19/20 Plan

Annual Rate639 -

Numerator170

Denominator26,620 27,396

18/19 Plan 19/20 Plan

Annual (%)82.5%

Numerator132

Denominator160


Please set out the overall plan in the HWB area for reducing rates of admission to residential and nursing homes for people over the age of 65, including any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric.

Please set out the overall plan in the HWB area for increasing the proportion of older people who are still at home 91 days after discharge from hospital into reablement/rehabilitation, including any assessment of how the schemes and enabling activity for Health and Social Care Integration are expected to impact on the metric.

Comments

8.4 Reablement



Long-term support needs of older people (age 65 and over) met by admission to residential and nursing care homes, per 100,000 population (aged 65+) population projections are based on a calendar year using the 2016 based Sub-National Population Projections for Local Authorities in England;

Comments


8.3 Residential Admissions

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Theme Code

Planning Requirement Key considerations for meeting the planning requirementThese are the Key Lines of Enquiry (KLOEs) underpinning the Planning Requirements (PR)

Please confirm whether your BCF plan meets the Planning Requirement?

Please note any supporting documents referred to and relevant page numbers to assist the assurers

Where the Planning requirement is not met, please note the actions in place towards meeting the requirement

Where the Planning requirement is not met, please note the anticipated timeframe for meeting it

PR1 A jointly developed and agreed plan that all parties sign up to

Has a plan; jointly developed and agreed between CCG(s) and LA; been submitted?Has the HWB approved the plan/delegated approval pending its next meeting?Have local partners, including providers, VCS representatives and local authority service leads (including housing and DFG leads) been involved in the development of the plan?Do the governance arrangements described support collaboration and integrated care?Where the strategic narrative section of the plan has been agreed across more than one HWB, have individual income, expenditure, metric and HICM sections of the plan been submitted for each HWB concerned?

<Please Select>

PR2 A clear narrative for the integration of health and social care

Is there a narrative plan for the HWB that describes the approach to delivering integrated health and social care that covers:- Person centred care, including approaches to delivering joint assessments, promoting choice, independence and personalised care?- A clear approach at HWB level for integrating services that supports the overall approach to integrated care and confirmation that the approach supports delivery at the interface between health and social care?- A description of how the local BCF plan and other integration plans e.g. STP/ICSs align?- Is there a description of how the plan will contribute to reducing health inequalities (as per section 4 of the Health and Social Care Act) and to reduce inequalities for people with protected characteristics under the Equality Act 2010? This should include confirmation that equality impacts of the local BCF plan have been considered, a description of local priorities related to health inequality and equality that the BCF plan will contribute to addressing.Has the plan summarised any changes from the previous planning period? And noted (where appropriate) any lessons learnt?

<Please Select>

PR3 A strategic, joined up plan for DFG spending

Is there confirmation that use of DFG has been agreed with housing authorities?Does the narrative set out a strategic approach to using housing support, including use of DFG funding that supports independence at home.In two tier areas, has: - Agreement been reached on the amount of DFG funding to be passed to district councils to cover statutory Disabled Facilities Grants? or - The funding been passed in its entirety to district councils?

<Please Select>


PR4 A demonstration of how the area will maintain the level of spending on social care services from the CCG minimum contribution to the fund in line with the uplift in the overall contribution

Does the total spend from the CCG minimum contribution on social care match or exceed the minimum required contribution (auto-validated on the planning template)?

Yes


PR5 Has the area committed to spend at equal to or above the minimum allocation for NHS commissioned out of hospital services from the CCG minimum BCF contribution?

Does the total spend from the CCG minimum contribution on non-acute, NHS commissioned care exceed the minimum ringfence (auto-validated on the planning template)?

Yes


PR6 Is there a plan for implementing the High Impact Change Model for managing transfers of care?

Does the BCF plan demonstrate a continued plan in place for implementing the High Impact Change Model for Managing Transfers of Care?Has the area confirmed the current level of implementation and the planned level at March 2020 for all eight changes?Is there an accompanying overall narrative setting out the priorities and approach for ongoing implementation of the HICM?Does the level of ambition set out for implementing the HICM changes correspond to performance challenges in the system?If the current level of implementation is below established for any of the HICM changes, has the plan included a clear explanation and set of actions towards establishing the change as soon as possible in 2019-20?

<Please Select>


Better Care Fund 2019/20 Template9. Confirmation of Planning Requirements

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PR7 Is there a confirmation that the components of the Better Care Fund pool that are earmarked for a purpose are being planned to be used for that purpose?

Have the planned schemes been assigned to the metrics they are aiming to make an impact on?Expenditure plans for each element of the BCF pool match the funding inputs? (auto-validated)Is there confirmation that the use of grant funding is in line with the relevant grant conditions? (tick-box)Is there an agreed plan for use of the Winter Pressures grant that sets out how the money will be used to address expected demand pressures on the Health system over Winter?Has funding for the following from the CCG contribution been identified for the area?- Implementation of Care Act duties?- Funding dedicated to carer-specific support?- Reablement?

<Please Select>

PR8 Indication of outputs for specified scheme types

Has the area set out the outputs corresponding to the planned scheme types (Note that this is only for where any of the specified set of scheme types requiring outputs are planned)? (auto-validated)

<Please Select>

Metrics

PR9 Does the plan set stretching metrics and are there clear and ambitious plans for delivering these?

Is there a clear narrative for each metric describing the approach locally to meeting the ambition set for that metric?Is there a proportionate range of scheme types and spend included in the expenditure section of the plan to support delivery of the metric ambitions for each of the metrics?Do the narrative plans for each metric set out clear and ambitious approaches to delivering improvements?Have stretching metrics been agreed locally for:- Metric 2: Long term admission to residential and nursing care homes- Metric 3: Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement

<Please Select>


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